Provider Demographics
NPI:1659323442
Name:NORTH HUDSON COMMUNITY ACTION CORPORATION
Entity Type:Organization
Organization Name:NORTH HUDSON COMMUNITY ACTION CORPORATION
Other - Org Name:MOBILE VAN
Other - Org Type:Other Name
Authorized Official - Title/Position:INTERIM PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABABB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-866-2388
Mailing Address - Street 1:800 31ST ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2428
Mailing Address - Country:US
Mailing Address - Phone:201-210-0100
Mailing Address - Fax:201-348-0100
Practice Address - Street 1:5301 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2622
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:201-392-9084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0022705Medicaid
NJ311829Medicare Oscar/Certification