Organization
NEW HANOVER COMMUNITY HEALTH CENTER INCORPORATED
Active
Parent organization
NEW HANOVER COMMUNITY HEALTH CENTER INCORPORATED
Other names
Lakeside Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEW HANOVER COMMUNITY HEALTH CENTER INCORPORATED
Authorized official
ALTHEA ANNETTE JOHNSON (CEO)
(910) 202-8623
Entity
Organization
Contact information
Practice address
1805 S 13TH ST, WILMINGTON, NC 28401-6469
(910) 772-5552
Mailing address
925 N 4TH ST, WILMINGTON, NC 28401-3450
(910) 343-0270
(910) 251-1540
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34-1923
MEDICARE FACILITY IDENTIFICATION NUMBER
—
Enumeration date
06/19/2008
Last updated
11/09/2023
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