Provider Demographics
NPI:1639713068
Name:HENRY J AUSTIN HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HENRY J AUSTIN HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-278-5939
Mailing Address - Street 1:321 N WARREN ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4794
Mailing Address - Country:US
Mailing Address - Phone:609-278-5900
Mailing Address - Fax:609-396-1526
Practice Address - Street 1:218 N BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08608-1306
Practice Address - Country:US
Practice Address - Phone:609-278-5900
Practice Address - Fax:609-695-3532
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENRY J AUSTIN HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)