Provider Demographics
NPI:1083197719
Name:SUN RIVER HEALTH INC
Entity Type:Organization
Organization Name:SUN RIVER HEALTH INC
Other - Org Name:WESTCHESTER SQUARE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-745-3611
Mailing Address - Street 1:PO BOX 5036
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-5036
Mailing Address - Country:US
Mailing Address - Phone:914-734-8800
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:2510 WESTCHESTER AVENUE
Practice Address - Street 2:WESTCHESTER SQUARE HEALTH CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3585
Practice Address - Country:US
Practice Address - Phone:855-681-8700
Practice Address - Fax:718-299-1420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUN RIVER HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-10
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5901200R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW38731OtherGROUP MEDICARE
NY00473038Medicaid