Provider Demographics
NPI:1629950969
Name:ANTHONY L. JORDAN HEALTH CENTER
Entity type:Organization
Organization Name:ANTHONY L. JORDAN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TALENT ACQUISITION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CYTHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-719-1906
Mailing Address - Street 1:53 DORBETH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3213
Mailing Address - Country:US
Mailing Address - Phone:585-230-5890
Mailing Address - Fax:
Practice Address - Street 1:82 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2131
Practice Address - Country:US
Practice Address - Phone:585-423-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY51-P136969-01Medicaid
NYP136969-01Medicaid