Provider Demographics
NPI:1578564001
Name:COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:COMPREHENSIVE COMMUITY DEVELOPMENT CORPORATION
Other - Org Name:SOUNDVIEW HEALTHCARE NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPADA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:718-589-2232
Mailing Address - Street 1:731 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2631
Mailing Address - Country:US
Mailing Address - Phone:718-589-8324
Mailing Address - Fax:718-860-1838
Practice Address - Street 1:731 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2631
Practice Address - Country:US
Practice Address - Phone:718-589-8324
Practice Address - Fax:718-860-1838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QC1500X, 261QM1300X
NY7000239R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7000239ROtherOPERATING CERTIFICATE
NY00665274Medicaid
NY00665274Medicaid
NY331825Medicare Oscar/Certification
NYW92171Medicare PIN