NPIMap

Organization Active NPI

Henry J Austin Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Trenton, NJ
National Provider Identifier
1114101607
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
22436 Issued in NJ
Legal business name
HENRY J AUSTIN HEALTH CENTER, INC
Practice address
112 Ewing St
Trenton, NJ 08609-1004
Phone
(609) 396-9600
Fax
(609) 695-3532
NPI assigned
Dec 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Charles L Davis II
Title
Ceo
Phone
(609) 278-5970

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 22436 NJ Primary

Addresses

Primary practice location

112 Ewing St
Trenton, NJ 08609-1004

Mailing address

112 Ewing St
Trenton, NJ 08609-1004
Phone (609) 396-9600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040720001061 NJ Part A Provider - Federally Qualified Health Center (FQHC) 9739179409 Practice locations: Trenton, NJ

Federally qualified health center certification: CCN 311823

Legal name
HENRY J AUSTIN HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 10, 1993
Last certification
Aug 10, 1993
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Feb 19, 1986 in NJ
Enrollment address
112 Ewing St
Trenton, NJ 86091004

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Henry Jaustin Health Center at All Access Mental Health13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

314 E State St
#316
Trenton, NJ 08608
Phone (609) 396-4258

112 Ewing St
Trenton, NJ 08609
Phone (609) 278-6033

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Alfonso Llano Individual Corporate DirectorBoard Member Jun 1, 2018
Detravius Bethea Individual Corporate DirectorBoard Member Jun 1, 2017
Nancy Perez Individual W-2 Managing EmployeeProvider Enrollment & Credentialing Dec 22, 2014
Beverly a Smith Individual Corporate DirectorBoard Member Jun 1, 2017
Laurence Ganges Individual Corporate DirectorBoard Member Jun 1, 2018
Chinweze N Ahagotu Individual Corporate DirectorBoard Member Jun 1, 2018
Daniel R Benson Individual Corporate DirectorBoard Member Jun 1, 2017
Tyrone Gaskins Individual Corporate DirectorBoard Member Jun 1, 2017
Dekia Smith Individual Corporate DirectorBoard Member Jun 1, 2018
Charles L Davis Individual W-2 Managing EmployeeChief Executive Officer May 6, 2024
Operational/Managerial ControlChief Executive Officer May 6, 2024

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1114101607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 EWING ST",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086091004",
            "telephone_number": "609-396-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 EWING ST",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086091004",
            "telephone_number": "609-396-9600",
            "fax_number": "609-695-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY J AUSTIN HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "609-278-5970",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "II"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "22436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trenton, NJ

Sources for this page

Verify at the official NPI Registry.