NPIMap

Organization Active NPI

Care for the Homeless

Doing business as Morris Avenue Health Center

  • Federally Qualified Health Center (FQHC)
  • Bronx, NY
National Provider Identifier
1811656515
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARE FOR THE HOMELESS
Doing business as
Morris Avenue Health Center
Practice address
Morris Avenue Health Center
528 Morris Avenue
Bronx, NY 10451
Phone
(718) 691-6464
Fax
(347) 823-1561
NPI assigned
Dec 10, 2021
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
John Chue, CPA, CGMA
Title
Chief Financial Officer
Phone
(212) 366-4459

Specialties & licenses 1

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

Addresses

Primary practice location

Morris Avenue Health Center
528 Morris Avenue
Bronx, NY 10451

Mailing address

30 E 33Rd St FL 5
New York, NY 10016-5337
Phone (212) 366-4459

Other identifiers 1

IdentifierTypeStateIssuer
03064422MedicaidNY

Other names 1

  • Morris Avenue Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190129003068 NY Part B Supplier - Clinic/Group Practice 9830240332 Receives reassigned benefits from 28 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bronx, NY; Brooklyn, NY
O20220818002161 NY Part A Provider - Federally Qualified Health Center (FQHC) 9830240332 Practice locations: Bronx, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811656515. Details of each certification follow.

Federally qualified health center certification: CCN 571839

Legal name
CARE FOR THE HOMELESS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 13, 2022
Last certification
Jul 13, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2011 in NY
Enrollment address
528 Morris Ave
Bronx, NY 10451-5509

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Care for the Homeless12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Fulvia Frazier Individual OtherBoard Member Jan 1, 2021
Mariya Kamenetskaya Individual OtherBoard Member Jan 1, 2021
Timothy Karcher Individual OtherBoard Member Jan 1, 2021
Lloyd E Bailey Individual OtherBoard Member Jan 1, 2021
Philip Malebranche Individual OtherBoard Member Jan 1, 2021
Frances a Melendez Individual OtherBoard Member Jan 1, 2021
Alfred Aeterburn Individual OtherBoard Member Jan 1, 2021
Jane Parker Individual OtherBoard Member Jan 1, 2021
Surjit Chana Individual OtherBoard Member Jan 1, 2021
Delise Dupont Blenman Individual OtherBoard Member Jan 1, 2021
Harry K Thomas Individual OtherBoard Member Jan 1, 2021
Robert Heckart Individual OtherBoard Member Jan 1, 2021
Grigor Licul Individual OtherBoard Member Jan 1, 2021
Regina Olasin Individual Contracted Managing EmployeeCmo Jun 1, 2017
Corporate OfficerCmo/Managerial Mar 14, 2016
Operational/Managerial ControlCmo/Managerial Mar 15, 2016
Amanda Fialk Individual OtherBoard Member Jan 1, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1639094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1811656515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E 33RD ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100165337",
            "telephone_number": "212-366-4459",
            "fax_number": "347-823-1561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MORRIS AVENUE HEALTH CENTER",
            "address_2": "528 MORRIS AVENUE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10451",
            "telephone_number": "718-691-6464",
            "fax_number": "347-823-1561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARE FOR THE HOMELESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-10",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "CHUE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "212-366-4459",
        "authorized_official_credential": "CPA, CGMA"
    },
    "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": "03064422",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Morris Avenue Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.