Provider Demographics
NPI:1851507214
Name:NEW HANOVER COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:NEW HANOVER COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:910-254-4690
Mailing Address - Street 1:925 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-3450
Mailing Address - Country:US
Mailing Address - Phone:910-254-4690
Mailing Address - Fax:910-251-1540
Practice Address - Street 1:925 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3450
Practice Address - Country:US
Practice Address - Phone:910-254-4690
Practice Address - Fax:910-251-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0155POtherBLUECROSS BLUESHIELD
NC344555Medicaid
NC8700429OtherMEDICAID (HIV CASE MGMT)
341840Medicare ID - Type Unspecified