Provider Demographics
NPI:1891878971
Name:CHEROKEE COMMUNITY CARE, LLC
Entity Type:Organization
Organization Name:CHEROKEE COMMUNITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:CONNIE
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-488-1333
Mailing Address - Street 1:1307 N LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2026
Mailing Address - Country:US
Mailing Address - Phone:864-488-1333
Mailing Address - Fax:864-488-3004
Practice Address - Street 1:1307 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2026
Practice Address - Country:US
Practice Address - Phone:864-488-1333
Practice Address - Fax:864-488-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC118Medicaid
SCRHC118Medicaid