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Community Health Care

Organization Active NPI Community Health Clinic/Center · Lakebay, WA

NPI 1699375345 · NPPES record last updated Oct 30, 2020

Key facts

NPI
1699375345
Entity type
Organization (NPI type 2)
Primary specialty
Community Health Clinic/Center 261QC1500X
Legal business name
COMMUNITY HEALTH CARE
Practice address
15610 89TH St. CT. KPN
Lakebay, WA 98349-9840
Phone
(253) 597-4550
NPI assigned
Oct 30, 2020
Organization subpart
No

Authorized official

Name
David Flentge
Title
President/Ceo
Phone
(253) 597-4550

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 33

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

View all 33

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 72

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WA

Federally qualified health center certification: CCN 501001

Legal name
COMMUNITY HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 2, 2021
Last certification
Dec 2, 2021
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Incorporated
Apr 24, 1987 in WA
Enrollment address
15610 89TH Street CT NW
Lakebay, WA 98349-9551

All disclosed owners & managing parties 1

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

NameRoleSinceShare
David Flentge
Individual 		Corporate Director Jan 19, 2011 100%
W-2 Managing Employee Mar 16, 2011 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20211201001934 WA Part a Provider - Federally Qualified Health Center (FQHC) 1850201559 Practice locations: Lakebay, WA

National Provider Directory

Tax ID family
Family Clinic (34 organizations share this tax ID)

Locations

22100 108th Ave E
Graham, WA 98338
Phone (253) 354-4315

10510 Gravelly Lake Dr SW
Tacoma, WA 98499
Phone (253) 589-7030

11225 Pacific Ave S
Tacoma, WA 98444
Phone (253) 536-2020

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Yes

Addresses

Primary practice location

15610 89TH St. CT. KPN
Lakebay, WA 98349-9840

Mailing address

1148 Broadway Ste 100
Tacoma, WA 98402-3518
Phone (253) 597-4550

Other names

  • Key Medical Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 30, 2020.

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1699375345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1148 BROADWAY STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023518",
            "telephone_number": "253-597-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15610 89TH ST. CT. KPN",
            "city": "LAKEBAY",
            "state": "WA",
            "postal_code": "983499840",
            "telephone_number": "253-597-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-30",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "FLENTGE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "253-597-4550"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Key Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakebay, WA

All providers in Lakebay, WA · Community Health Clinic/Center in Washington

Sources for this page

Verify at the official NPI Registry.