Healthcare Provider Details

I. General information

NPI: 1730303017
Provider Name (Legal Business Name): APICHA COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BROADWAY
NEW YORK NY
10013-3698
US

IV. Provider business mailing address

400 BROADWAY
NEW YORK NY
10013-3698
US

V. Phone/Fax

Practice location:
  • Phone: 212-334-6029
  • Fax: 212-334-7957
Mailing address:
  • Phone: 212-334-6029
  • Fax: 212-334-7957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TERESITA R RODRIGUEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 212-334-7940