MEDICARE: NORTH HUDSON COMMUNITY ACTION CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346494788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH HUDSON COMMUNITY ACTION CORPORATION

Provider Business Mailing Address
First Line	:	800 31ST ST
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-2428
Country	:	US
Telephone Number	:	201-210-0100
Fax Number	:	201-348-0100

Provider Business Practice Location Address
First Line	:	535 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1658
Country	:	US
Telephone Number	:	973-340-1182
Fax Number	:	973-340-1186

Authorized Official
Title or Position	:	INTERIM PRESIDENT/CEO
Name	:	MICHAEL SHABABB
Credential	:
Telephone Number	:	201-866-2388

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	05/28/2013

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