Provider Demographics
NPI:1457626129
Name:ANTHONY L. JORDAN HEALTH CORPORATION
Entity Type:Organization
Organization Name:ANTHONY L. JORDAN HEALTH CORPORATION
Other - Org Name:ANDREWS TERRACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-423-2878
Mailing Address - Street 1:82 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2131
Mailing Address - Country:US
Mailing Address - Phone:585-423-5800
Mailing Address - Fax:585-423-2860
Practice Address - Street 1:125 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609
Practice Address - Country:US
Practice Address - Phone:585-325-5232
Practice Address - Fax:585-546-3485
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTHONY L. JORDAN HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2701211R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16467AOtherMEDICARE PART B
NY6613OtherBLUE CROSS OF ROCHESTER
NY00384969Medicaid
NY331838OtherMEDICARE PART A
NYG0187295590OtherBLUE CHOICE OF ROCHESTER