Provider Demographics
NPI:1619568227
Name:IRONBOUND COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:IRONBOUND COMMUNITY HEALTH CENTER INC
Other - Org Name:HOPE & ESPERANZA COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NURIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-PABON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-433-9773
Mailing Address - Street 1:788 MOUNT PROSPECT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3221
Mailing Address - Country:US
Mailing Address - Phone:973-433-9773
Mailing Address - Fax:
Practice Address - Street 1:788 MOUNT PROSPECT AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3221
Practice Address - Country:US
Practice Address - Phone:973-433-9773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty