Provider Demographics
NPI:1679846943
Name:WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Other - Org Name:REGENT FAMILY RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINDOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-316-7906
Mailing Address - Street 1:2720 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3939
Mailing Address - Country:US
Mailing Address - Phone:212-749-1820
Mailing Address - Fax:212-932-8323
Practice Address - Street 1:2720 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3939
Practice Address - Country:US
Practice Address - Phone:212-749-1820
Practice Address - Fax:212-932-8323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-17
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002243R320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02999264Medicaid
NY02999264Medicaid