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General NPI Number Information
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NPI Number | 1205474681
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Entity Type | Organization
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Legal Business Name | JERICHO ROAD MINISTRIES, INC.
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Dates
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Enumeration Date | 12/16/2019
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Last Update Date | 08/23/2021
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Provider Practice Location Address
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Address Line | 100 E TUPPER ST
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City | BUFFALO
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State | NY
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Zip | 14203-1315
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Country | US
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Telephone | 716-881-6191
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E TUPPER ST
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City | BUFFALO
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State | NY
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Zip | 14203-1315
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Country | US
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Telephone | 716-919-6870
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Fax | 716-919-6871
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JACKIE ENDRESS
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Credential |
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Telephone | 716-348-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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