NPIMap

Organization Active NPI

Intercare Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Eau Claire, MI
National Provider Identifier
1861402067
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INTERCARE COMMUNITY HEALTH NETWORK
Practice address
6270 W Main St
Eau Claire, MI 49111
Phone
(269) 461-6927
Fax
(269) 461-3068
NPI assigned
Aug 9, 2006
Last updated
Nov 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

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

Authorized official

Name
Velma Hendershott
Title
President Ceo
Phone
(269) 427-7937

Specialties & licenses 1

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

Addresses

Primary practice location

6270 W Main St
Eau Claire, MI 49111

Mailing address

50 Industrial Park Dr
Bangor, MI 49013
Phone (269) 427-7937

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123000154 MI Part A Provider - Federally Qualified Health Center (FQHC) 9537061254 Practice locations: Eau Claire, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861402067. Details of each certification follow.

Federally qualified health center certification: CCN 231830

Legal name
INTERCARE COMMUNITY HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1971 in MI
Enrollment address
6270 W Main St
Eau Claire, MI 49111-9480

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Intercare Community Health Network16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Velma Hendershot Individual Corporate OfficerCeo/President Aug 11, 1986
Corporate DirectorCeo/President Aug 11, 1986
W-2 Managing Employee Aug 11, 1986
Karen Freeburn Individual Corporate OfficerChair of Board Jan 1, 2002
Corporate DirectorChair of Board Jan 1, 2002

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1861402067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 INDUSTRIAL PARK DR",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "49013",
            "telephone_number": "269-427-7937",
            "fax_number": "269-427-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6270 W MAIN ST",
            "city": "EAU CLAIRE",
            "state": "MI",
            "postal_code": "49111",
            "telephone_number": "269-461-6927",
            "fax_number": "269-461-3068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCARE COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "HENDERSHOTT",
        "authorized_official_first_name": "VELMA",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "269-427-7937"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eau Claire, MI

Sources for this page

Verify at the official NPI Registry.