Provider Demographics
NPI:1770002446
Name:KAGMAN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:KAGMAN COMMUNITY HEALTH CENTER INC
Other - Org Name:KAGMAN COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:670-287-8089
Mailing Address - Street 1:PO BOX 5723
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-5556
Mailing Address - Country:US
Mailing Address - Phone:670-287-4484
Mailing Address - Fax:
Practice Address - Street 1:1 LEMMAI WAY
Practice Address - Street 2:PO BOX 5723 CHRB
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-256-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP22150-0001-1261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)