Provider Demographics
NPI:1164948733
Name:EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.
Other - Org Name:EAST LIBERTY FAMILY HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:412-362-6353
Mailing Address - Street 1:7171 CHURCHLAND ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1217
Mailing Address - Country:US
Mailing Address - Phone:412-345-7840
Mailing Address - Fax:
Practice Address - Street 1:373 BURROWS ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2201
Practice Address - Country:US
Practice Address - Phone:412-661-2802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)