Provider Demographics
NPI:1851873640
Name:SYRACUSE COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SYRACUSE COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/COO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-234-5942
Mailing Address - Street 1:819 SOUTH SALINA STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-476-7921
Mailing Address - Fax:315-475-1448
Practice Address - Street 1:819 SOUTH SALINA STREET
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-476-7921
Practice Address - Fax:315-475-1448
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYRACUSE COMMUNITY HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03003876Medicaid
NY00474204Medicaid