Basic Information
| Provider Information | |||||||||
| NPI: | 1558720235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DHCH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 195 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313858677 | ||||||||
| FaxNumber: | 6313850611 | ||||||||
| Practice Location | |||||||||
| Address1: | 195 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313858677 | ||||||||
| FaxNumber: | 6313850611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2016 | ||||||||
| LastUpdateDate: | 06/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | DUPITON | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | BRIDGET | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6313858677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 5153208R | 01 | NY | OPERATING CERTIFICATE | OTHER |