Provider Demographics
NPI:1730317769
Name:WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Other - Org Name:THELMA C DAVIDSON ADAIR WILLIAM F. RYAN COMMUNITY HEALTH CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-222-5221
Mailing Address - Street 1:565 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5250
Mailing Address - Country:US
Mailing Address - Phone:212-222-5221
Mailing Address - Fax:
Practice Address - Street 1:565 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5250
Practice Address - Country:US
Practice Address - Phone:212-222-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-29
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03178452Medicaid
NY331006Medicare Oscar/Certification