National Provider Identifier
Anthony L. Jordan Health Corporation
Anthony L. Jordan Health Corporation is listed in the NPPES registry with a primary specialty of Federally Qualified Health Center (FQHC) in Rochester, NY and a listed phone number of (585) 254-6480.
Profile Overview
- NPI
- 1013291335
- Provider Type
- Organization
- Primary Specialty
- Federally Qualified Health Center (FQHC)
- Enumeration Date
- October 05, 2011
- Last Updated
- February 04, 2025
Practice Location
- 322 Lake Ave
- Brown Square Center
- Rochester, NY 14608-1162
Phone: (585) 254-6480
Mailing Address
- 82 Holland St
- Aljhc
- Rochester, NY 14605-2131
Specialties
- Federally Qualified Health Center (FQHC) (261QF0400X)
Full Record
- NPI
- 1013291335
- Entity Type
- Organization
- EIN
- <UNAVAIL>
- Organization Name
- Anthony L. Jordan Health Corporation
- Other Organization Name
- <Unavail>
- Provider Other Organization Name Type Code
- 6
- Mailing Street Address
- 82 Holland St
- Mailing Address Line 2
- Aljhc
- Mailing City
- Rochester
- Mailing State
- NY
- Mailing ZIP Code
- 14605-2131
- Mailing Country
- US
- Mailing Phone
- (585) 423-5800
- Mailing Fax
- (585) 423-2890
- Practice Street Address
- 322 Lake Ave
- Practice Address Line 2
- Brown Square Center
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14608-1162
- Practice Country
- US
- Practice Phone
- (585) 254-6480
- Practice Fax
- (585) 254-1092
- Enumeration Date
- October 05, 2011
- Last Updated
- February 04, 2025
- Authorized Official Last Name
- Harbin
- Authorized Official First Name
- Janice
- Authorized Official Title
- President/CEO
- Authorized Official Phone
- (585) 423-5800
- Organization Subpart
- Yes
- Parent Organization Name
- ANTHONY L. JORDAN HEALTH CORPORATION
- Parent Organization TIN
- <UNAVAIL>
- Authorized Official Credential Text
- DDS
- Certification Date
- February 04, 2025
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Federally Qualified Health Center (FQHC) (261QF0400X)
- Other Identifiers
- 16467A (NY, Medicare Part B), 6613 (NY, Blue Cross Of Rochester), 331838 (NY, Medicare Part A), G0187295590 (NY, Blue Choice Of Rochester), 03800906 (NY)