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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