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Community Health Care

Organization Active NPI Community Health Clinic/Center · Tacoma, WA

NPI 1043970908 · NPPES record last updated Apr 29, 2024

Key facts

NPI
1043970908
Entity type
Organization (NPI type 2)
Primary specialty
Community Health Clinic/Center 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
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 33

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

View all 33

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 72

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WA

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
Corporation · Non-profit
Incorporated
Apr 24, 1987 in WA
Enrollment address
737 Fawcett Ave
Tacoma, WA 98402-5503

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 Officer
Board Member		 Jan 1, 2021
William Speaker
Individual 		Corporate Officer
Board Member		 Jan 1, 2021
Marco Viniegra
Individual 		Corporate Director
Board Chair		 Jan 1, 2021
Lynese Cammack
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Ladedria Griffin Stallworth
Individual 		Corporate Director
Board Member		 Jan 1, 2021
David Flentge
Individual 		Corporate Officer
President & Ceo		 Jan 19, 2011 100%
W-2 Managing Employee
President/Ceo		 Jan 19, 2011 100%
Boaz Kealy
Individual 		Corporate Officer
Board Member		 Jan 1, 2021

Medicare enrollment records

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

National Provider Directory

Tax ID family
Family Clinic (34 organizations share this tax ID)

Specialties & licenses

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

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

  • CLR Clinic Other name

Other providers in Tacoma, WA

All providers in Tacoma, WA · Community Health Clinic/Center in Washington

Sources for this page

Verify at the official NPI Registry.