Provider Demographics
NPI:1265651020
Name:MORRIS HEIGHTS HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MORRIS HEIGHTS HEALTH CENTER, INC.
Other - Org Name:MHHC AT WALTON AVENUE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER, PROVIDER ENROLLMENT & MANA
Authorized Official - Prefix:
Authorized Official - First Name:PAMELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-483-1270
Mailing Address - Street 1:85 W BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4015
Mailing Address - Country:US
Mailing Address - Phone:718-716-4400
Mailing Address - Fax:718-294-6912
Practice Address - Street 1:25 E 183RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1242
Practice Address - Country:US
Practice Address - Phone:718-716-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000236R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00590390Medicaid