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) 454-7530.

NPI 1568711596Rochester, NYFederally Qualified Health Center (FQHC)

Profile Overview

NPI
1568711596
Provider Type
Organization
Primary Specialty
Federally Qualified Health Center (FQHC)
Enumeration Date
September 06, 2012
Last Updated
October 08, 2015

Practice Location

  • 151 Parsells Ave
  • Jordan Health At Community Place
  • Rochester, NY 14609

Phone: (585) 454-7530

Mailing Address

  • 82 Holland St
  • Aljhc
  • Rochester, NY 14605-2131

Specialties

  • Federally Qualified Health Center (FQHC) (261QF0400X)
Full Record
NPI
1568711596
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
151 Parsells Ave
Practice Address Line 2
Jordan Health At Community Place
Practice City
Rochester
Practice State
NY
Practice ZIP Code
14609
Practice Country
US
Practice Phone
(585) 454-7530
Enumeration Date
September 06, 2012
Last Updated
October 08, 2015
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
updated_by_file
npidata_pfile_20050523-20260308.csv
Taxonomies
Federally Qualified Health Center (FQHC) (261QF0400X)
Other Identifiers
331838 (NY, Medicare Part A Ptan), 16467A (NY, Medicare Part B Ptan), 04065629 (NY)