NPIMap

Organization Active NPI

Mount Vernon Neighborhood Health Center, Inc.

Doing business as Westchester Community Health Center Greenburgh

  • Federally Qualified Health Center (FQHC)
  • White Plains, NY
National Provider Identifier
1225287402
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
5903200R Issued in NY
Legal business name
MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.
Doing business as
Westchester Community Health Center Greenburgh
Practice address
295 Knollwood Rd
White Plains, NY 10607
Phone
(914) 699-7200
Fax
(914) 699-0837
NPI assigned
Sep 12, 2008
Last updated
Aug 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Maxine Lewis
Title
Director Patient Financial Services
Phone
(914) 989-7600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 5903200R NY Primary

Addresses

Primary practice location

295 Knollwood Rd
White Plains, NY 10607

Mailing address

107 W 4TH St
Mount Vernon, NY 10550-4002
Phone (914) 699-7200

Other identifiers 1

IdentifierTypeStateIssuer
00926581MedicaidNY

Other names 1

  • Westchester Community Health Center Greenburgh Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060808000423 NY Part A Provider - Federally Qualified Health Center (FQHC) 0345139671 1 other NPI on this enrollment
Practice locations: White Plains, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225287402. Details of each certification follow.

Federally qualified health center certification: CCN 331815

Legal name
MOUNT VERNON NEIGHBORHOOD HEALTH CENTER INC
Doing business as
WESTCHESTER COMMUNITY HEALTH CENTER GREENBURGH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Dec 14, 2004 in NY
Enrollment address
295 Knollwood Rd
White Plains, NY 10607-1822

Other NPIs with the same Medicare PAC ID 3

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
Mt Vernon Neighborh HLTH10 organizations share this tax ID, including this one
Part of
Mt Vernon Neighborh HLTH

Other organizations with this tax ID 9

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

Locations

295 Knollwood Rd
White Plains, NY 10607
Phone (914) 699-7200

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Nicholas Cicchettie Individual Corporate DirectorBoard Member Dec 1, 2007
Donna Marable Individual Corporate DirectorBoard Member Apr 18, 2022
Sakai Brown Individual Corporate DirectorBoard Member Apr 18, 2022
Ty Milburn Individual Corporate DirectorBoard Member Jan 19, 2021
Karen Ford Individual Corporate DirectorBoard Member Sep 17, 2019
Duarte Geraldino Individual Corporate DirectorBoard Member Dec 16, 2022
Hopeton a White Individual Corporate DirectorBoard Member Jan 2, 2007
Judith Watson Individual 5% Or Greater Indirect Ownership Interest Nov 19, 2019 5%
Corporate DirectorCeo Nov 19, 2019
W-2 Managing EmployeeCeo Nov 19, 2019
Troy Grant Individual Corporate DirectorBoard Member Jan 19, 2021
Sonia Hamilton Individual Corporate Director Jul 13, 2020
Maxine Lewis Individual Corporate DirectorDpa May 4, 2020
William Long Individual Corporate DirectorBoard Member Jan 19, 2021

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1225287402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 W 4TH ST",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105504002",
            "telephone_number": "914-699-7200",
            "fax_number": "914-699-0837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "295 KNOLLWOOD RD",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "10607",
            "telephone_number": "914-699-7200",
            "fax_number": "914-699-0837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.",
        "enumeration_date": "2008-09-12",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "MAXINE",
        "authorized_official_title_or_position": "DIRECTOR PATIENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "914-989-7600"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NY",
            "license": "5903200R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00926581",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westchester Community Health Center Greenburgh",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Plains, NY

Sources for this page

Verify at the official NPI Registry.