Organization
URBAN HEALTH PLAN, INC.
Active
Parent organization
BELLA VISTA COMMUNITY HEALTH CENTER
Other names
BELLA VISTA COMMUNITY HEALTH CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
BELLA VISTA COMMUNITY HEALTH CENTER
Authorized official
DR. SAMUEL DELEON JR. M.D. (VP MEDICAL AFFAIRS/CMO)
(718) 589-2440
Entity
Organization
Contact information
Practice address
882 HUNTS POINT AVE, BRONX, NY 10474-5402
(718) 589-2440
Mailing address
1065 SOUTHERN BLVD, BRONX, NY 10459-2417
(718) 589-2440
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02994952
GROUP MEDICAID ID
NY
05
—
03410166
—
NY
01
—
331016
FACILITY MEDICARE ID #
NY
Enumeration date
12/22/2010
Last updated
10/17/2012
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