NPIMap

Organization Active NPI

Aaron E. Henry Community Health Services Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Clarksdale, MS
National Provider Identifier
1144227901
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC
Practice address
800 Ohio Ave
Clarksdale, MS 38614-7200
Phone
(662) 624-4292
Fax
(662) 624-4354
NPI assigned
Jul 7, 2005
Last updated
Jan 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Authorized official

Name
Ms. Aurelia Taylor
Title
Cheif Executive Officer
Phone
(662) 624-4292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

800 Ohio Ave
Clarksdale, MS 38614-7200

Mailing address

510 Highway 322
P O Box 1216
Clarksdale, MS 38614-4717
Phone (662) 624-4292

Other identifiers 1

IdentifierTypeStateIssuer
09010039MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100916001345 MS Part A Provider - Federally Qualified Health Center (FQHC) 1153230560 Practice locations: Clarksdale, MS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144227901. Details of each certification follow.

Federally qualified health center certification: CCN 251832

Legal name
AARON E HENRY COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1979 in MS
Enrollment address
800 Ohio Ave
Clarksdale, MS 38614-7200

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
Aaron E Henry Community Health18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

800 Ohio Ave
Clarksdale, MS 38614
Phone (662) 624-2504

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Tracey Rosebud Individual Corporate DirectorBoard Member Oct 15, 2013 100%
Raymond Cole Individual Corporate Director May 11, 1994
Orlando Paden Individual Corporate DirectorBoard Member Feb 20, 2012 100%
Georgia Tolliver Individual Corporate DirectorBoard Member Apr 13, 2004 100%
Lydia Rios Individual Corporate Director May 17, 2010
Larry Haynes Individual Corporate Director Sep 21, 1989
Aurelia Jones-Taylor Individual Corporate Director Jun 5, 1989
W-2 Managing Employee Jun 5, 1989
Josephine Rhymes Individual Corporate Director Jan 12, 1994
Robert Jackson Individual Corporate Director May 11, 2004

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674691200000",
    "number": "1144227901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HIGHWAY 322",
            "address_2": "P O BOX 1216",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386144717",
            "telephone_number": "662-624-4292",
            "fax_number": "662-624-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 OHIO AVE",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386147200",
            "telephone_number": "662-624-4292",
            "fax_number": "662-624-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AARON E. HENRY COMMUNITY HEALTH SERVICES CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2023-01-26",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "AURELIA",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "662-624-4292",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09010039",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

Verify at the official NPI Registry.