NPIMap

Organization Active NPI

Community Health Care, Inc.

Doing business as CompleteCare Health Network

  • Federally Qualified Health Center (FQHC)
  • Vineland, NJ
National Provider Identifier
1699089847
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
24405 Issued in NJ
Legal business name
COMMUNITY HEALTH CARE, INC.
Doing business as
CompleteCare Health Network
Practice address
1255 Landis Avenue
Vineland, NJ 08360-3423
Phone
(856) 451-4700
Fax
(856) 794-7183
NPI assigned
Jul 29, 2010
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 24405 NJ Primary

Addresses

Primary practice location

1255 Landis Avenue
Vineland, NJ 08360-3423

Mailing address

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

Other names 1

  • CompleteCare Health Network Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190125000400 NJ Part A Provider - Federally Qualified Health Center (FQHC) 9335040419 Practice locations: Vineland, NJ

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1699089847. Details of each certification follow.

Federally qualified health center certification: CCN 311941

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 18, 2018
Last certification
Dec 18, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1255 Landis Avenue
Vineland, NJ 83603462

Federally qualified health center certification: CCN 311894

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COMPLETECARE VINELAND RITE CARE MED PROFESSIONALS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 29, 2010
Last certification
Dec 29, 2010
Ownership / control type
For profit – corporation
Facility address
1255 Landis Avenue, Unit 1
Vineland, NJ 08360

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

Ownership & related parties

All disclosed owners & managing parties 12

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 Director Jan 1, 2024
Demetrica Todd-Ruiz Individual Corporate Director Jan 1, 2024
James C Edwards Individual Corporate OfficerPresident/Ceo Jan 1, 2024
Victor Cruz Individual Corporate Director Jan 1, 2024
Claudia Villalpando Individual Corporate DirectorDirector of Business Jan 1, 2024
Gladwyn D Baptist Individual Corporate Director Jan 1, 2024
Beverly L Dairsow Individual Corporate Director Jan 1, 2024
Dulce Gomez Individual Corporate Director Jan 1, 2024
Richie Elwell Individual Corporate DirectorVice President Jan 1, 2024
Dina Bruno Individual Corporate Director Jan 1, 2024
W-2 Managing EmployeeBusiness Associate Nov 1, 2016
Arthur Horn Individual Corporate Director Jan 1, 2024
James Quinn Individual Corporate Director Jan 1, 2024

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.

NPI Registry JSON

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1699089847",
    "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",
            "fax_number": "856-794-7183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 LANDIS AVENUE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083603423",
            "telephone_number": "856-451-4700",
            "fax_number": "856-794-7183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "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": "NJ",
            "license": "24405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CompleteCare Health Network",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CompleteCare Health Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.