Provider Demographics
NPI:1790270999
Name:TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Entity Type:Organization
Organization Name:TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Other - Org Name:COMMWELL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-567-7065
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-0340
Mailing Address - Country:US
Mailing Address - Phone:910-567-6194
Mailing Address - Fax:
Practice Address - Street 1:1470 MAPLE GROVE CHURCH ROAD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-7988
Practice Address - Country:US
Practice Address - Phone:877-935-5255
Practice Address - Fax:910-236-2118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI COUNTY COMMUNITY HEALTH COUNCIL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-29
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-082-014261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101161Medicaid