Provider Demographics
NPI:1356927594
Name:COMMUNITY OF HOPE HEALTH CLINIC- A VOLUNTEERS IN MEDICINE CLINIC
Entity type:Organization
Organization Name:COMMUNITY OF HOPE HEALTH CLINIC- A VOLUNTEERS IN MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ROYCE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-644-8641
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-0177
Mailing Address - Country:US
Mailing Address - Phone:205-644-8641
Mailing Address - Fax:205-574-3128
Practice Address - Street 1:2692 PELHAM PKWY STE E
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1337
Practice Address - Country:US
Practice Address - Phone:205-644-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health