Provider Demographics
NPI:1013291335
Name:ANTHONY L. JORDAN HEALTH CORPORATION
Entity Type:Organization
Organization Name:ANTHONY L. JORDAN HEALTH CORPORATION
Other - Org Name:BROWN SQUARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-423-5800
Mailing Address - Street 1:82 HOLLAND ST
Mailing Address - Street 2:ALJHC
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2131
Mailing Address - Country:US
Mailing Address - Phone:585-423-5800
Mailing Address - Fax:585-423-2890
Practice Address - Street 1:322 LAKE AVE
Practice Address - Street 2:BROWN SQUARE CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1162
Practice Address - Country:US
Practice Address - Phone:585-254-6480
Practice Address - Fax:585-254-1092
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTHONY L. JORDAN HEALTH CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-05
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2701211R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY16467AOtherMEDICARE PART B
NY6613OtherBLUE CROSS OF ROCHESTER
NY331838OtherMEDICARE PART A
NYG0187295590OtherBLUE CHOICE OF ROCHESTER
NY03800906Medicaid