Provider Demographics
NPI:1487694832
Name:PATERSON COMMUNITY HEALTH CENTER, INC.
Entity type:Organization
Organization Name:PATERSON COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-790-6594
Mailing Address - Street 1:32 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1775
Mailing Address - Country:US
Mailing Address - Phone:973-790-6594
Mailing Address - Fax:973-790-7703
Practice Address - Street 1:32 CLINTON ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1775
Practice Address - Country:US
Practice Address - Phone:973-790-6594
Practice Address - Fax:973-790-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ82304261QF0400X
NJ71672261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0044342Medicaid
NJ0044300Medicaid
NJ31-1810Medicare PIN