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General NPI Number Information
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NPI Number | 1417393018
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Entity Type | Organization
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Legal Business Name | OAK ORCHARD COMMUNITY HEALTH CENTER INC
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Dates
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Enumeration Date | 05/22/2013
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 81 SOUTH MAIN ST
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City | WARSAW
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State | NY
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Zip | 14569
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Country | US
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Telephone | 585-637-3905
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Fax | 585-637-2375
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Provider Business Mailing Address
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Address Line | 300 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1118
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Country | US
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Telephone | 585-637-3905
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Fax | 585-637-2375
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Authorized Official
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Title or Position | SPECIAL PROGRAM BILLING COORD
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Name | ELLEN CARMESTRO
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Credential |
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Telephone | 585-637-3905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1000X
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Taxonomy Name | Migrant Health Clinic/Center
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License Number |
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License Number State | NY
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Taxonomy #3
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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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