NPIMap

Organization Active NPI

Community Health Care

  • Community Health Clinic/Center
  • Tacoma, WA
National Provider Identifier
1043970908
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
COMMUNITY HEALTH CARE
Practice address
737 Fawcett Ave
Tacoma, WA 98402-5503
Phone
(253) 830-5969
NPI assigned
Dec 20, 2021
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Flentge
Title
President/Ceo
Phone
(253) 597-4450

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

737 Fawcett Ave
Tacoma, WA 98402-5503

Mailing address

1148 Broadway Ste 100
Tacoma, WA 98402-3518
Phone (253) 722-2161

Other names 1

  • CLR Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221101001530 WA Part A Provider - Federally Qualified Health Center (FQHC) 1850201559 Practice locations: Tacoma, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043970908. Details of each certification follow.

Federally qualified health center certification: CCN 501009

Legal name
COMMUNITY HEALTH CARE
Doing business as
COMMUNITY HEALTH CARE - CLR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 2022
Last certification
Nov 1, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 24, 1987 in WA
Enrollment address
737 Fawcett Ave
Tacoma, WA 98402-5503

Other NPIs with the same Medicare PAC ID 12

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Chcds-Lakewood Clinic34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

Organizations that report the same tax identification number in the National Provider Directory.

View all 33

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ken Repp Individual Corporate OfficerBoard Member Jan 1, 2021
William Speaker Individual Corporate OfficerBoard Member Jan 1, 2021
Marco Viniegra Individual Corporate DirectorBoard Chair Jan 1, 2021
Lynese Cammack Individual Corporate DirectorBoard Member Jan 1, 2021
Ladedria Griffin Stallworth Individual Corporate DirectorBoard Member Jan 1, 2021
David Flentge Individual Corporate OfficerPresident & Ceo Jan 19, 2011 100%
W-2 Managing EmployeePresident/Ceo Jan 19, 2011 100%
Boaz Kealy Individual Corporate OfficerBoard Member Jan 1, 2021

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1043970908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1148 BROADWAY STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023518",
            "telephone_number": "253-722-2161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 FAWCETT AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025503",
            "telephone_number": "253-830-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-20",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "FLENTGE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "253-597-4450"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CLR Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "CLR Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.