Organization
ANTHONY L. JORDAN HEALTH CORPORATION
Active
Parent organization
ANTHONY L. JORDAN HEALTH CORPORATION
Other names
Glenwood Gardens
Organization subpart
Yes
Provider details
NPI number
Legal business name
ANTHONY L. JORDAN HEALTH CORPORATION
Authorized official
DR. BRIDGETTE WIEFLING MD (PRESIDENT/CEO)
(585) 423-2878
Entity
Organization
Contact information
Practice address
41 KESTREL ST, ROCHESTER, NY 14613-2120
(585) 697-7130
(585) 697-7131
Mailing address
82 HOLLAND STREET, ROCHESTER, NY 14605-2131
(585) 423-5800
(585) 423-2806
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2701211R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00384969
—
NY
01
—
16467A
MEDICARE PART B
NY
01
—
331838
MEDICARE PART A
NY
01
—
6613
BLUE CROSS OF ROCHESTER
NY
01
—
G0187295590
BLUE CHOICE OF ROCHESTER
NY
Enumeration date
03/13/2012
Last updated
03/19/2012
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