Basic Information
| Provider Information | |||||||||
| NPI: | 1922234954 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNION COMMUNITY HEALTH CTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 EAST 188TH STREET | ||||||||
| Address2: | UNION COMMUNITY HEALTH | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189603817 | ||||||||
| FaxNumber: | 7189603824 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 EAST 188TH STREET | ||||||||
| Address2: | UNION COMMUNITY HEALTH | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104585302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189603817 | ||||||||
| FaxNumber: | 7189603824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2009 | ||||||||
| LastUpdateDate: | 06/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | HAYE | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | FINANCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7189603346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | FINANCE MANAGER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 02391353 | 05 | NY | MEDICAID |