New Hanover Community Health Center Incorporated

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

NEW HANOVER COMMUNITY HEALTH CENTER INCORPORATED

Doing business as

Lakeside Wellness Center

Practice address

1805 S 13TH St
Wilmington, NC 28401-6469

Phone

(910) 772-5552

NPI assigned

Jun 19, 2008

Last updated

Nov 9, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

NEW HANOVER COMMUNITY HEALTH CENTER INCORPORATEDAs reported in NPPES

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

Authorized official

Name

Althea Annette Johnson

Title

Ceo

Phone

(910) 202-8623

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lakeside Wellness Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457512766. Details of each certification follow.

• CCN 341923 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 341923

Legal name

LAKESIDE WELLNESS CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 18, 2007

Last certification

Oct 18, 2007

Ownership / control type

For profit – corporation

Facility address

1805 South 13TH Street
Wilmington, NC 28401

Part of

New Hanover Community Health Center Dba Mednorth Health Center

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

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1457512766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 N 4TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284013450",
            "telephone_number": "910-343-0270",
            "fax_number": "910-251-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 S 13TH ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284016469",
            "telephone_number": "910-772-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW HANOVER COMMUNITY HEALTH CENTER INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW HANOVER COMMUNITY HEALTH CENTER INCORPORATED",
        "enumeration_date": "2008-06-19",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ALTHEA",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-202-8623"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FACILITY IDENTIFICATION NUMBER",
            "identifier": "34-1923",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lakeside Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• New Hanover Chiropractic Clinic
• New Hanover Community Health Center (MedNorth Health Center Inc.)
• New Hanover Community Health Center Dba Mednorth Health Center
• New Hanover Community Health Center Incorporated (MedNorth Health Center)
• New Hanover Community Health Center Incorporated (MedNorth Health Center at Calhoun Drive)
• New Hanover Community Health Center Incorporated (MedNorth Health Center)
• New Hanover Community Health Center, Inc. (MedNorth Health Center)
• New Hanover Community Health Center, Inc.
• New Hanover County (New Hanover County Department of Social Services)
• New Hanover County (New Hanover County Health Department)

• Federally Qualified Health Center (FQHC) in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Federally Qualified Health Center (FQHC) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.