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General NPI Number Information
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NPI Number | 1407637234
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Entity Type | Organization
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Legal Business Name | BEACON CHRISTIAN COMMUNITY HEALTH CENTER INC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 2031 FOREST AVE STE 2
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1796
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Country | US
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Telephone | 718-815-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 2079 FOREST AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10303-1865
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Country | US
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Telephone | 718-815-6560
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID HOI KIM
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Credential |
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Telephone | 718-815-6560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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