Basic Information
| Provider Information | |||||||||
| NPI: | 1942795943 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARCARE COMMUNITY HEALTH NETWORK INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6010 BAY PKWY STE 901 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112046081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183093321 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112052735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189630800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2018 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRAUN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF RCM | ||||||||
| AuthorizedOfficialTelephone: | 7183093321 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PARCARE COMMUNITY HEALTH NETWORK INC | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 03970367 | 05 | NY | MEDICAID |