1962568915 NPI number — STEUBEN COUNTY, DBA STEUBEN COUNTY COMMUNITY SERVICES SUBSTANCE &ALCOH

Table of content: (NPI 1962568915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962568915 NPI number — STEUBEN COUNTY, DBA STEUBEN COUNTY COMMUNITY SERVICES SUBSTANCE &ALCOH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEUBEN COUNTY, DBA STEUBEN COUNTY COMMUNITY SERVICES SUBSTANCE &ALCOH
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:
STEUBEN COUNTY COMMUNITY SERVICES - SA
Provider Other Organization Name Type Code:
3
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:
1962568915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 LIBERTY STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14810-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-664-2255
Provider Business Mailing Address Fax Number:
607-664-2162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14810-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-776-6577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
607-664-2255

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112630100 . This is a "ACS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00930089 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7342561 . This is a "GHI BMP NYSHIP VO FHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000426190 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 105427AM . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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