Provider Demographics
NPI:1053845297
Name:COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Entity type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF LUBBOCK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:806-765-2611
Mailing Address - Street 1:1610 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-2622
Mailing Address - Country:US
Mailing Address - Phone:806-765-2611
Mailing Address - Fax:
Practice Address - Street 1:1610 5TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2622
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74509101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty