Healthcare Provider Details

I. General information

NPI: 1972059467
Provider Name (Legal Business Name): METRO COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 LIVINGSTON ST LOWR LEVEL
BROOKLYN NY
11201-7000
US

IV. Provider business mailing address

979 CROSS BRONX EXPY APT 11B
BRONX NY
10460-4885
US

V. Phone/Fax

Practice location:
  • Phone: 718-855-7707
  • Fax:
Mailing address:
  • Phone: 718-665-7565
  • Fax: 718-750-3448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: XAYVEON WILLIAMS
Title or Position: CONTRACT & CREDENTIALING MANAGER
Credential:
Phone: 718-665-7565