Community Health Care
Organization Active NPI Community Health Clinic/Center · Tacoma, WA
NPI 1407076110 · NPPES record last updated Jun 7, 2019
Key facts
- NPI
- 1407076110
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- COMMUNITY HEALTH CARE
- Practice address
- 1202 Martin Luther King Jr. Way
Tacoma, WA 98405 - Phone
- (253) 597-3813
- Fax
- (253) 597-3815
- NPI assigned
- Apr 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. David Flentge
- Title
- Ceo
- Phone
- (253) 597-4550
Other NPIs with the same Medicare PAC ID 12
Corporate family (same tax ID) 33
Practitioners 72
-
Abigail Kress, D.O
-
James G Lenhart, M.D.
-
Monica M Aparicio, ARNP
-
Shauna N Applin, ARNP
-
Stacie Sutton Beck, M.D.
-
Stacy Ann Beckman, PA-C
-
Jalyn Benca, DNP
-
Dahna Berkson, PHD
-
Aleksandr Borishkevich, PA-C
-
Carolina M Breed, PA-C
-
Virginia Ann Buccola, PMHNP
-
Stephen G Cook, MD
-
Henry Davis, MD
-
Vladimir Dzhashi, MD
-
Marjut Feltamo, LICSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Federally qualified health center certification: CCN 501868
- Legal name
- COMMUNITY HEALTH CARE
- Doing business as
- HILLTOP REGIONAL HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 1, 2001
- Last certification
- Nov 1, 2001
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 24, 1987 in WA
- Enrollment address
- 1202 Martin Luther King Jr Way
Tacoma, WA 98405-3926
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Alma Price |
Corporate Officer |
Jan 1, 2022 | |
| Ken Repp |
Corporate Officer |
Jan 1, 2022 | |
| William Speaker |
Corporate Officer |
Jan 1, 2022 | |
| James M Satt |
Corporate Officer |
Jan 1, 2022 | |
| Marco Viniegra |
Corporate Officer |
Jan 1, 2022 | |
| Lynese Cammack |
Corporate Officer |
Jan 1, 2022 | |
| Ladedria Griffin Stallworth |
Corporate Officer |
Jan 1, 2022 | |
| David Flentge |
Corporate Officer |
Jan 19, 2011 | |
| W-2 Managing Employee |
Jan 19, 2011 | ||
| Boaz Kealy |
Corporate Officer |
Jan 1, 2022 | |
| Katie Parker |
Corporate Officer |
Jan 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110228000284 | WA | Part a Provider - Federally Qualified Health Center (FQHC) | 1850201559 | Practice locations: Tacoma, WA |
National Provider Directory
- Tax ID family
- Family Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Yes |
Addresses
Primary practice location
1202 Martin Luther King Jr. Way
Tacoma, WA 98405
Mailing address
1148 Broadway Ste 100
Tacoma, WA 98402-3518
Phone (253) 597-4550
Other names
- Hilltop Regional Health Center
Other providers in Tacoma, WA
- Community Health Care
- Community Health Care
- Community Health Care
- Community Health Care
- Community Health Care
- Community Health Care
- Community Health Care
- Community Health Care
- Community Health Care
- Community Health Care
All providers in Tacoma, WA · Community Health Clinic/Center in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.