Provider Demographics
NPI:1023381100
Name:WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Other - Org Name:SHERIDAN PREPARATORY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:SHIPPEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-591-4459
Mailing Address - Street 1:920 LARK DRIVE
Mailing Address - Street 2:WHITNEY M. YOUNG JR. INC.
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207
Mailing Address - Country:US
Mailing Address - Phone:518-465-4771
Mailing Address - Fax:518-242-4770
Practice Address - Street 1:400 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2920
Practice Address - Country:US
Practice Address - Phone:518-465-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-20
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0101205R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473565Medicaid