Provider Demographics
NPI:1801938709
Name:COMMUNITY HEALTHCARE NETWORK, INC
Entity type:Organization
Organization Name:COMMUNITY HEALTHCARE NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DJIBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-545-2439
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:FLOOR 5
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 1:9704 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-4721
Practice Address - Country:US
Practice Address - Phone:718-657-7088
Practice Address - Fax:718-657-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYACG6747343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331957Medicare Oscar/Certification
NY00695941Medicaid