Basic Information
| Provider Information | |||||||||
| NPI: | 1427371012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNION COMMUNITY HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4487 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104571526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609465 | ||||||||
| FaxNumber: | 7189603824 | ||||||||
| Practice Location | |||||||||
| Address1: | 4487 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104571526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609465 | ||||||||
| FaxNumber: | 7189603824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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| AuthorizedOfficialLastName: | HARTNETT | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7189609465 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CFO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | 02064111 | 05 | NY | MEDICAID |