Provider Demographics
NPI:1619148160
Name:NEWARK COMMUNITY HEALTH CENTERS,INC.
Entity Type:Organization
Organization Name:NEWARK COMMUNITY HEALTH CENTERS,INC.
Other - Org Name:JAMES WHITE MANOR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-483-1300
Mailing Address - Street 1:516 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1639
Mailing Address - Country:US
Mailing Address - Phone:973-648-0866
Mailing Address - Fax:973-648-0078
Practice Address - Street 1:516 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1639
Practice Address - Country:US
Practice Address - Phone:973-648-0866
Practice Address - Fax:973-648-0078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWARK COMMUNITY HEALTH CENTERS,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-12
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22238261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0055701Medicaid
NJ0055701Medicaid