Provider Demographics
NPI:1164948733
Name:EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:EAST LIBERTY FAMILY HEALTH CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-345-0412
Mailing Address - Street 1:7157 MARY PECK BOND PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1236
Mailing Address - Country:US
Mailing Address - Phone:412-345-0412
Mailing Address - Fax:412-661-2802
Practice Address - Street 1:1425 FORBES AVE FL 2
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5140
Practice Address - Country:US
Practice Address - Phone:412-345-0412
Practice Address - Fax:412-661-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)