NPIMap

Organization Active NPI

North Hudson Community Action Corporation

  • Federally Qualified Health Center (FQHC)
  • Garfield, NJ
National Provider Identifier
1346494788
Registry record updated May 28, 2013
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
535 Midland Ave
Garfield, NJ 07026-1658
Phone
(973) 340-1182
Fax
(973) 340-1186
NPI assigned
Nov 12, 2008
Last updated
May 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2013

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

Authorized official

Name
Michael Shababb
Title
Interim President/Ceo
Phone
(201) 866-2388

Specialties & licenses 1

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

Addresses

Primary practice location

535 Midland Ave
Garfield, NJ 07026-1658

Mailing address

800 31St St
Union City, NJ 07087-2428
Phone (201) 210-0100

Other identifiers 1

IdentifierTypeStateIssuer
0106933MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061013000393 NJ Part A Provider - Federally Qualified Health Center (FQHC) 6103887997 1 other NPI on this enrollment
Practice locations: Garfield, NJ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346494788. Details of each certification follow.

Federally qualified health center certification: CCN 311868

Legal name
NORTH HUDSON COMMUNITY ACTION CORPORATION
Doing business as
N/A
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 4, 2006
Last certification
Dec 4, 2006
Ownership / control type
Non-profit – church related
Organization structure
CorporationProprietary
Incorporated
Oct 29, 1965 in NJ
Enrollment address
535 Midland Ave
Garfield, NJ 70261658

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

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 24

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

NameRoleSinceShare
Oscar Lanza Individual Corporate Director Nov 9, 2006
Ganga Rastogi Individual Corporate Director Apr 15, 2009
Yousef Abdallah Individual Corporate Director Nov 9, 2006
Maria Almeida Individual Corporate Director Nov 9, 2006
Juan Antonio Villalobos Individual Corporate Director Apr 15, 2009
Michael Shababb Individual Corporate OfficerCfo Nov 17, 2006
Corporate Director Nov 17, 2006
W-2 Managing Employee Nov 17, 2006
Paul Valdivia Individual Corporate Director Apr 15, 2009
David Krusznis Individual Corporate Director Apr 15, 2009
Erika Zucconi Individual Corporate Director Apr 15, 2009
Altagracia Gutierrez Individual Corporate Director Nov 28, 2006
Hansel Asmar Individual Corporate Director Apr 15, 2009
Marisol Acosta Individual Corporate Director Oct 29, 2012
Joanne Martin Individual Corporate Director Nov 9, 2006
Robert Divincent Individual Corporate Director Nov 9, 2006
Lizaida Ortega Individual Corporate Director Apr 15, 2009
Mary Ocasio Individual Corporate Director Nov 9, 2006
Maria Cainas Individual Corporate Director Nov 9, 2006
Barbara Phillips Individual Corporate Director Apr 15, 2009
Annia Cabrera Individual Corporate Director Jun 9, 2009
Richard Dwyer Individual Corporate Director Nov 9, 2006
Steven Smith Individual Corporate Director Nov 9, 2006
Nadia Cabana Individual Corporate Director Apr 15, 2009
Richard Censullo Individual Corporate Director Nov 9, 2006
Deanine Muniz Individual Corporate Director Apr 15, 2009

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": "1226448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369699200000",
    "number": "1346494788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 31ST ST",
            "city": "UNION CITY",
            "state": "NJ",
            "postal_code": "070872428",
            "telephone_number": "201-210-0100",
            "fax_number": "201-348-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 MIDLAND AVE",
            "city": "GARFIELD",
            "state": "NJ",
            "postal_code": "070261658",
            "telephone_number": "973-340-1182",
            "fax_number": "973-340-1186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH HUDSON COMMUNITY ACTION CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-12",
        "last_updated": "2013-05-28",
        "status": "A",
        "authorized_official_last_name": "SHABABB",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "INTERIM 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": "0106933",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garfield, NJ

Sources for this page

Verify at the official NPI Registry.