Provider Demographics
NPI:1912642885
Name:CHPCOMMUNITY
Entity Type:Organization
Organization Name:CHPCOMMUNITY
Other - Org Name:HEALTHY LIVING COMMUNITY FOUNDATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADSKE-SUCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CSCS
Authorized Official - Phone:515-635-1285
Mailing Address - Street 1:12303 WELLINGTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8109
Mailing Address - Country:US
Mailing Address - Phone:515-635-1285
Mailing Address - Fax:515-635-1286
Practice Address - Street 1:12303 WELLINGTON RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8109
Practice Address - Country:US
Practice Address - Phone:515-635-1285
Practice Address - Fax:515-635-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty