NPIMap

Organization Active NPI

Community Health Care, Inc.

Doing business as CompleteCare Health Network- Woodbury

  • Federally Qualified Health Center (FQHC)
  • Woodbury, NJ
National Provider Identifier
1235535113
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE, INC.
Doing business as
CompleteCare Health Network- Woodbury
Practice address
75 W Red Bank Ave
Woodbury, NJ 08096-1694
Phone
(856) 451-4700
Fax
(856) 848-2879
NPI assigned
Nov 5, 2014
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
James C Edwards
Title
President/Ceo
Phone
(856) 451-4700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 24816 NJ

Addresses

Primary practice location

75 W Red Bank Ave
Woodbury, NJ 08096-1694

Mailing address

14 N Pearl St
Bridgeton, NJ 08302-1902
Phone (856) 451-4700

Other names 1

  • CompleteCare Health Network- Woodbury Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150109001039 NJ Part A Provider - Federally Qualified Health Center (FQHC) 9335040419 Practice locations: Woodbury, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235535113. Details of each certification follow.

Federally qualified health center certification: CCN 311918

Legal name
COMMUNITY HEALTH CARE, INC.
Doing business as
COMPLETECARE HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2014
Last certification
Dec 1, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 29, 1986 in NJ
Enrollment address
75 W Red Bank Ave
Woodbury, NJ 80961694

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Community HLTH Care Inc12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

715 Delsea Dr N
Ste 3
Glassboro, NJ 08028

785 W Sherman Ave
Vineland, NJ 08360

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Maria Laboy Individual Corporate DirectorBoard Member May 12, 2014
Demetrica Todd-Ruiz Individual Corporate DirectorBoard Member May 12, 2014
James C Edwards Individual Corporate OfficerCeo/President Jan 1, 2015
Corporate DirectorCeo/President Jan 1, 2015
Victor Cruz Individual Corporate DirectorBoard Member Jan 1, 2016
Claudia Villalpando Individual W-2 Managing EmployeeDirector of Business Jun 1, 2013
Gladwyn D Baptist Individual Corporate DirectorBoard Member May 12, 2014
Beverly L Dairsow Individual Corporate Director Jan 1, 2016
Dulce Gomez Individual Corporate DirectorBoard Member Jan 1, 2015
Richie Elwell Individual Corporate OfficerExecutive VP of Business Jun 1, 2013
Dina Bruno Individual W-2 Managing EmployeeBusiness Associate Nov 1, 2016
Arthur Horn Individual Corporate DirectorBoard Member Apr 1, 2004
James Quinn Individual Corporate DirectorBoard Member May 12, 2014
Paul Cooper Individual Corporate DirectorBoard Member May 12, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Completecare Health NetworkBridgeton, NJ, CCN 311807 Federally qualified health center Operational/Managerial Control (100%) Jun 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 5

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": "1415145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1235535113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 N PEARL ST",
            "city": "BRIDGETON",
            "state": "NJ",
            "postal_code": "083021902",
            "telephone_number": "856-451-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 W RED BANK AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080961694",
            "telephone_number": "856-451-4700",
            "fax_number": "856-848-2879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-05",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "856-451-4700"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NJ",
            "license": "24816",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CompleteCare Health Network- Woodbury",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CompleteCare Health Network- Woodbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbury, NJ

Sources for this page

Verify at the official NPI Registry.