NPIMap

Organization Active NPI

Intercare Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Bangor, MI
National Provider Identifier
1992818835
Registry record updated Jan 3, 2008
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
308 Charles St
Bangor, MI 49013
Phone
(269) 427-7967
Fax
(269) 427-9539
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

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 Primary

Addresses

Primary practice location

308 Charles St
Bangor, MI 49013

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
O20040123000299 MI Part A Provider - Federally Qualified Health Center (FQHC) 9537061254 Practice locations: Bangor, MI

Federally qualified health center certification: CCN 231832

Legal name
INTERCARE COMMUNITY HEALTH NETWORK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1992
Last certification
Oct 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 2, 1971 in MI
Enrollment address
308 Charles St
Bangor, MI 49013-1317

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Patrick Sullivan Individual Corporate DirectorDirector of Finance Sep 1, 2008
Velma Hendershot Individual Corporate OfficerCeo/ President Aug 11, 1986
W-2 Managing EmployeeCeo/President Aug 11, 1996
Karen Freeburn Individual Corporate DirectorBoard Member-Chair Jan 1, 2002

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1992818835",
    "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": "308 CHARLES ST",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "49013",
            "telephone_number": "269-427-7967",
            "fax_number": "269-427-9539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCARE COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-01-03",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, MI

Sources for this page

Verify at the official NPI Registry.