NPIMap

Organization Active NPI

William F Ryan Community Health Center Inc

Doing business as Regent Family Residence

  • Mental Illness Community Based Residential Treatment Facility
  • New York, NY
National Provider Identifier
1679846943
Registry record updated Nov 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
7002243R Issued in NY
Legal business name
WILLIAM F RYAN COMMUNITY HEALTH CENTER INC
Doing business as
Regent Family Residence
Practice address
2720 Broadway
New York, NY 10025-3939
Phone
(212) 749-1820
Fax
(212) 932-8323
NPI assigned
Feb 17, 2012
Last updated
Nov 19, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLIAM F RYAN COMMUNITY HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2015

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

Authorized official

Name
Brian McIndoe
Title
President & Ceo
Phone
(212) 316-7906

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X 7002243R NY Primary

Addresses

Primary practice location

2720 Broadway
New York, NY 10025-3939

Mailing address

2720 Broadway
New York, NY 10025-3939
Phone (212) 749-1820

Other identifiers 1

IdentifierTypeStateIssuer
02999264MedicaidNY

Other names 1

  • Regent Family Residence Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679846943. Details of each certification follow.

  • CCN 331061 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 331061

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
REGENT FAMILY RESIDENCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 23, 2012
Last certification
Aug 23, 2012
Ownership / control type
For profit – corporation
Facility address
2720 Broadway
Manhattan, NY 10025

National Provider Directory

National Provider Directory
Part of
Amy H Korobow MD

NPI Registry JSON

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

{
    "created_epoch": "1329436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1679846943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253939",
            "telephone_number": "212-749-1820",
            "fax_number": "212-932-8323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 BROADWAY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100253939",
            "telephone_number": "212-749-1820",
            "fax_number": "212-932-8323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM F RYAN COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLIAM F RYAN COMMUNITY HEALTH CENTER INC",
        "enumeration_date": "2012-02-17",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "MCINDOE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "212-316-7906"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NY",
            "license": "7002243R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02999264",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Regent Family Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.