Provider Demographics
NPI:1184657355
Name:CALEDONIAN HEALTH CENTER
Entity Type:Organization
Organization Name:CALEDONIAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-488-3736
Mailing Address - Street 1:270 FLATBUSH AVENUE EXT
Mailing Address - Street 2:C/O BERNADETTE SELBY, DIR. PATIENT ACCOUNTING
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3012
Mailing Address - Country:US
Mailing Address - Phone:718-488-3736
Mailing Address - Fax:
Practice Address - Street 1:1280 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3204
Practice Address - Country:US
Practice Address - Phone:718-488-3736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02461452Medicaid
NY287OtherEMPIRE BLUE CROSS
NY02461452Medicaid
NYWEP291Medicare ID - Type UnspecifiedGROUP NUMBER