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General NPI Number Information
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NPI Number | 1114137403
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTER OF RICHMOND, INC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 235 PORT RICHMOND AVENUE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1701
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Country | US
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Telephone | 718-876-1732
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Fax | 718-442-0189
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Provider Business Mailing Address
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Address Line | 235 PORT RICHMOND AVENUE
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City | STATEN ISLAND
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State | NY
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Zip | 10302-1701
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Country | US
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Telephone | 718-924-2254
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Fax | 718-442-0189
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT FINANCIAL SERVI
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Name | LUCIE GABRIEL
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Credential |
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Telephone | 718-924-2254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 7004210R
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 2903588
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License Number State | NY
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