NPIMap

Organization Active NPI

North Hudson Community Action Corporation

  • Federally Qualified Health Center (FQHC)
  • Hackensack, NJ
National Provider Identifier
1306090741
Registry record updated Nov 12, 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
25 E Salem St
Hackensack, NJ 07601-7427
Phone
(201) 996-2121
NPI assigned
Nov 12, 2008
Organization subpart
Yes
Parent organization
NORTH HUDSON COMMUNITY ACTION CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 12, 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

25 E Salem St
Hackensack, NJ 07601-7427

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0175081MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080909000683 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 1 other NPI on this enrollment
Practice locations: Hackensack, NJ

Federally qualified health center certification: CCN 311886

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 24, 2008
Last certification
Sep 24, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 1965 in NJ
Enrollment address
25E Salem St
Hackensack, NJ 76017427

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

Locations

197 S Van Brunt St
Englewood, NJ 07631
Phone (201) 537-4442

Ownership & related parties

All disclosed owners & managing parties 19

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
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 Feb 10, 2015
Joan Quigley Individual W-2 Managing EmployeeCeo Feb 10, 2015
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 Chairper Dec 18, 2006
Mariano Pellegrino Individual Corporate DirectorBoard Member Jul 30, 2012
Marisol Acosta Individual Corporate DirectorBoard Member Oct 29, 2012
Robert Divincent Individual Corporate DirectorBoard Member Sep 16, 2014
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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1226448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1306090741",
    "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": "25 E SALEM ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076017427",
            "telephone_number": "201-996-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH HUDSON COMMUNITY ACTION CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTH HUDSON COMMUNITY ACTION CORPORATION",
        "enumeration_date": "2008-11-12",
        "last_updated": "2008-11-12",
        "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": "0175081",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

Verify at the official NPI Registry.