Provider Demographics
NPI:1912436858
Name:COMMUNITY HEALTHCARE NETWORK, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE NETWORK, INC.
Other - Org Name:PHOENIX SCHOOL BASED HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE AND CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENGROFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-545-2439
Mailing Address - Street 1:60 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2439
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:504 W. 158TH STREET
Practice Address - Street 2:5TH FLOOR, ROOM 511
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7202
Practice Address - Country:US
Practice Address - Phone:917-521-3130
Practice Address - Fax:917-521-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7002119R261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid