Community Health Care, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Bridgeton, NJ
NPI 1720198740 · NPPES record last updated Mar 23, 2022
Key facts
- NPI
- 1720198740
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CARE, INC.
- Practice address
- 105 Manheim Ave
Bridgeton, NJ 08302-2139 - Phone
- (856) 451-4700
- Fax
- (856) 794-7183
- NPI assigned
- Aug 30, 2006
- Organization subpart
- No
Authorized official
- Name
- James C Edwards
- Title
- Ceo, President
- Phone
- (856) 451-4700
Owners & managing parties with NPI records 12
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 11
Related certifications (CCN) 1
Practitioners 129
-
Myriam S Cruz, MD
-
Mahbuba Akter, PA
-
Fawaz Anwar, DO
-
Sara Ausaf, MD
-
Priscila Ayala, PA-C
-
Nicole Babel, APN
-
Elizabeth Bevan, LCSW
-
Mysti Blizzard, APN
-
Aubrey Grace Boegly, APN
-
Eric M Bonifield, M.D.
-
Michael Patrick Bonk, M.D.
-
Gayatri Borra, M.D.
-
Natallia Breibart, D.O.
-
Sharon Brown, APN
-
Alexandra Rae Burrows, PA-C
-
Nicholas Calder, M.D.
-
O'Neil Chaudhry, MD
-
Shaniece Latoya Chavis, DNP, APN, FNP-BC
-
Joseph John Cipriano, DNP, FNP-BC
-
Jennifer Anne Clark, N.P.-C
-
Darlene Clendaniel, APN,PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Federally qualified health center certification: CCN 311807
- Legal name
- COMMUNITY HEALTH CARE, INC.
- Doing business as
- COMPLETECARE HEALTH NETWORK
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 1, 1992
- Last certification
- Jan 1, 1992
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 29, 1986 in NJ
- Enrollment address
- 105 Manheim Ave
Bridgeton, NJ 83022139
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Maria Laboy |
Corporate Director |
Apr 28, 2015 | |
| Demetrica Todd-Ruiz |
Corporate Director |
Apr 28, 2015 | |
| James C Edwards |
Corporate Officer |
Jan 1, 2015 | |
| Corporate Director |
Jan 1, 2015 | ||
| W-2 Managing Employee |
Jan 1, 2015 | ||
| Claudia Villalpando |
Corporate Director |
Jun 1, 2013 | |
| Gladwyn D Baptist |
Corporate Director |
Apr 28, 2015 | |
| Richie Elwell |
Corporate Director |
Jun 1, 2013 | |
| Dina Bruno |
W-2 Managing Employee |
Nov 1, 2016 | |
| Arthur Horn |
Corporate Director |
Apr 28, 2015 | |
| Javier Brambila |
Corporate Director |
Apr 28, 2015 | |
| James Quinn |
Corporate Director |
Apr 28, 2015 | |
| Community Health Care, Inc. |
Operational/Managerial Control | Jun 1, 2021 | 100% |
| Paul Cooper |
Corporate Director |
Apr 28, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101118000928 | NJ | Part a Provider - Federally Qualified Health Center (FQHC) | 9335040419 | Practice locations: Bridgeton, NJ |
National Provider Directory
- Tax ID family
- Community HLTH Care Inc
Locations
105 Manheim Ave
Ste 11
Bridgeton, NJ 08302
14 N Pearl St
Fl 2
Bridgeton, NJ 08302
105 Manheim Ave
Bridgeton, NJ 08302
Phone (609) 451-4700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| General Practice Dentistry |
1223G0001X | |||
| Optometrist |
152W00000X | |||
| Licensed Practical Nurse |
164W00000X | |||
| Midwife |
176B00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Infectious Disease Physician |
207RI0200X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Podiatrist |
213E00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
105 Manheim Ave
Bridgeton, NJ 08302-2139
Mailing address
14 N Pearl St
Bridgeton, NJ 08302-1902
Phone (856) 451-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0044806 | Medicaid | NJ |
Other names
- CompleteCare Health Network
Other providers in Bridgeton, NJ
- Brandon David Colle
- Community Health Care, Inc.
- Community Health Care, Inc.
- Community Health Care, Inc.
- Community Health Care, Inc.
- Community Health Care, Inc.
- Jeffrey T. Contino
- Christopher James Cook
- David J Cooney Jr.
- Fiore J Copare
All providers in Bridgeton, NJ · Federally Qualified Health Center (FQHC) in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2022. 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.