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General NPI Number Information
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NPI Number | 1619307022
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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 | 11/21/2013
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 21 DOAT STREET
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City | BUFFALO
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State | NY
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Zip | 14211-1612
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Country | US
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Telephone | 716-892-2775
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Fax | 716-597-0554
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Provider Business Mailing Address
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Address Line | 21 DOAT STREET
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City | BUFFALO
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State | NY
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Zip | 14211-1616
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Country | US
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Telephone | 716-892-2775
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Fax | 716-597-0554
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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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