Provider Demographics
NPI:1932370483
Name:NEWARK COMMUNITY HEALTH CENTERS, INC.
Entity Type:Organization
Organization Name:NEWARK COMMUNITY HEALTH CENTERS, INC.
Other - Org Name:DAYTON STREET HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-483-1300
Mailing Address - Street 1:101 LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-1108
Mailing Address - Country:US
Mailing Address - Phone:973-565-0355
Mailing Address - Fax:973-565-0461
Practice Address - Street 1:101 LUDLOW ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-1108
Practice Address - Country:US
Practice Address - Phone:973-565-0355
Practice Address - Fax:973-565-0461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWARKCOMMUNITY HEALTH CENTRS,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-12
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70778261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0409294Medicaid
NJ311820Medicare Oscar/Certification
NJ31-1820Medicare UPIN