NPIMap

Organization Active NPI

North Hudson Community Action Corporation

  • Federally Qualified Health Center (FQHC)
  • Passaic, NJ
National Provider Identifier
1124272232
Registry record updated Nov 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Practice address
148 - 8TH Street
Passaic, NJ 07055
Phone
(197) 347-0301
NPI assigned
Nov 17, 2008
Last updated
Nov 17, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
NORTH COMMUNITY ACTION CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2008

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

Authorized official

Name
Christopher F Irizarry
Title
President/Ceo
Phone
(201) 866-2388

Specialties & licenses 1

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

Addresses

Primary practice location

148 - 8TH Street
Passaic, NJ 07055

Mailing address

5301 Broadway
West New York, NJ 07093-2622
Phone (201) 866-9320

Other identifiers 1

IdentifierTypeStateIssuer
0168343MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080528000175 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 1 other NPI on this enrollment
Practice locations: Passaic, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124272232. Details of each certification follow.

Federally qualified health center certification: CCN 311882

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 15, 2008
Last certification
Jul 15, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 1965 in NJ
Enrollment address
220 Passaic St
Passaic, NJ 70556400

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
North Hudson Community Action Corporation14 organizations share this tax ID, including this one
Part of
North Hudson Community Action Corporation

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Pura Cabrera Individual Corporate DirectorBoard Member Jul 31, 2013
Juana Malave Individual Corporate DirectorBoard Member Jan 20, 2015
Joseph Muniz Individual Corporate DirectorBoard Member-Chairperson Apr 25, 2011
Maria Vila Individual Corporate DirectorBoard Member Jul 31, 2013
Michael Shababb Individual W-2 Managing EmployeeCfo Nov 18, 2014
Joan Quigley Individual Corporate OfficerCeo Jul 1, 2013
W-2 Managing EmployeeCeo Nov 18, 2014
Joan Woods Individual Corporate DirectorBoard Member-Secretary Mar 4, 2013
Silverio Vega Individual Corporate DirectorBoard Member Sep 16, 2014
Kim Nicoliello Individual Corporate DirectorBoard Member Mar 18, 2014
Christina McLellan Individual Corporate DirectorBoard Member Nov 28, 2013
Erika Zucconi Individual Corporate DirectorBoard Member-1St Vice Chairperso May 12, 2008
Mariano Pellegrino Individual Corporate DirectorBoard Member Jul 30, 2012
Marisol Acosta Individual Corporate DirectorBoard Member Oct 29, 2012
Robert Divincent Individual Corporate Director May 12, 2008
Lisa Snedeker Individual Corporate DirectorBoard Member Feb 24, 2015
Victor Grullon Individual Corporate DirectorBoard Member Dec 16, 2013
Wayne Cook Individual Corporate DirectorBoard Member Oct 31, 2014
Hilda R Roque Dieguez Individual Corporate DirectorBoard Member Oct 31, 2011
Linda Habermann Individual Corporate DirectorBoard Member Mar 18, 2014
Ulysses Isa Individual Corporate DirectorBoard Member Jun 29, 2009
Rosemary Roque Individual Corporate DirectorBoard Member Nov 29, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
North Hudson Community Action CorporationHarrison, NJ, CCN 311931 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2016
Feb 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226880000000",
    "number": "1124272232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 BROADWAY",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070932622",
            "telephone_number": "201-866-9320",
            "fax_number": "201-392-9084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 - 8TH STREET",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "07055",
            "telephone_number": "197-347-0301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH HUDSON COMMUNITY ACTION CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH COMMUNITY ACTION CORPORATION",
        "enumeration_date": "2008-11-17",
        "last_updated": "2008-11-17",
        "status": "A",
        "authorized_official_last_name": "IRIZARRY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "201-866-2388"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0168343",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Passaic, NJ

Sources for this page

Verify at the official NPI Registry.