1801977376 NPI number — HAMILTON COUNTY

Table of content: (NPI 1801977376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801977376 NPI number — HAMILTON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CERTIFIED HOME HEALTH AGENCY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801977376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12842-0250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-648-6141
Provider Business Mailing Address Fax Number:
518-648-6143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 WHITE BIRCH LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12842-0250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-648-6141
Provider Business Practice Location Address Fax Number:
518-648-6143
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOMLINSON
Authorized Official First Name:
ERICA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
518-648-6141

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  2055601 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02997386 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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