Provider Demographics
NPI:1760833008
Name:VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Other - Org Name:GREATER FULTON MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSPH, MBA
Authorized Official - Phone:804-253-1968
Mailing Address - Street 1:2809 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23222-3647
Mailing Address - Country:US
Mailing Address - Phone:804-780-0840
Mailing Address - Fax:804-329-1206
Practice Address - Street 1:1718 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-3428
Practice Address - Country:US
Practice Address - Phone:804-780-0840
Practice Address - Fax:804-780-0862
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-28
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)