Organization
JERICHO ROAD MINISTRIES INC.
Active
Organization
JERICHO ROAD MINISTRIES INC.
Active
Other names
Jericho Road Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE ENDRESS (CREDENTIALING SPECIALIST)
(716) 348-3000
Entity
Organization
Contact information
Practice address
184 BARTON ST, BUFFALO, NY 14213
(716) 881-6191
(716) 881-6247
Mailing address
184 BARTON ST, BUFFALO, NY 14213-1573
(716) 881-6191
(716) 881-6247
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1401237R
NYS OPERATING LICENSE
NY
Enumeration date
07/17/2013
Last updated
08/05/2025
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