Provider Demographics
NPI:1780801050
Name:WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES INC.
Entity type:Organization
Organization Name:WESTERN NORTH CAROLINA COMMUNITY HEALTH SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-285-0622
Mailing Address - Street 1:257 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4120
Mailing Address - Country:US
Mailing Address - Phone:828-285-0622
Mailing Address - Fax:828-285-9421
Practice Address - Street 1:257 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4120
Practice Address - Country:US
Practice Address - Phone:828-285-0622
Practice Address - Fax:828-285-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC344583AMedicaid
341866Medicare Oscar/Certification