Healthcare Provider Details

I. General information

NPI: 1952739054
Provider Name (Legal Business Name): COMMUNITY HEALTH CENTER OF RICHMOND INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1714
US

IV. Provider business mailing address

235 PORT RICHMOND AVE
STATEN ISLAND NY
10302-1701
US

V. Phone/Fax

Practice location:
  • Phone: 718-924-2254
  • Fax:
Mailing address:
  • Phone: 718-924-2254
  • Fax: 718-442-0189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: HENRY THOMPSON
Title or Position: CEO
Credential: FACHE
Phone: 718-924-2254