Organization
SUN RIVER HEALTH INC
Active
Parent organization
SUN RIVER HEALTH INC
Other names
Church Avenue Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUN RIVER HEALTH INC
Authorized official
ADAM K. LIPTON (VP INFO/PRACTICE MGMT SYSTEMS)
(914) 384-2375
Entity
Organization
Contact information
Practice address
2412 CHURCH AVENUE, CHURCH AVENUE CLINIC, BROOKLYN, NY 11226-4005
(855) 681-8700
(718) 299-1420
Mailing address
PO BOX 5036, WHITE PLAINS, NY 10602-5036
(914) 734-8800
(914) 734-8786
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
5901200R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00473038
—
NY
01
—
W38731
GROUP MEDICARE
NY
Enumeration date
09/07/2018
Last updated
03/14/2022
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