MEDICARE: SUN RIVER HEALTH INC

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	251B00000X	Case Management Agency
2	261QF0400X	Federally Qualified Health Center (FQHC)	5901200R	NY

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	:	1922426881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN RIVER HEALTH INC

Provider Business Mailing Address
First Line	:	1037 MAIN ST
Second Line	:	HUDSON RIVER HEALTHCARE, INC.
City	:	PEEKSKILL
State	:	NY
Zip	:	10566-2913
Country	:	US
Telephone Number	:	914-734-8800
Fax Number	:	914-734-8808

Provider Business Practice Location Address
First Line	:	750 UNION ST
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-3002
Country	:	US
Telephone Number	:	518-751-3060
Fax Number	:	845-765-9382

Authorized Official
Title or Position	:	VP INFO/PRACTICE MGMT SYSTEMS
Name	:	ADAM LIPTON
Credential	:
Telephone Number	:	914-384-2375

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	03/24/2022

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