1770655201 NPI number — FALLS HOME INC

Table of content: (NPI 1770655201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770655201 NPI number — FALLS HOME INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALLS HOME INC
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:
Provider Other Organization Name Type Code:
6
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:
1770655201
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SCHUYLER STREET
Provider Second Line Business Mailing Address:
PO BOX 829
Provider Business Mailing Address City Name:
MONTOUR FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14865-0829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-535-7165
Provider Business Mailing Address Fax Number:
607-535-2511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SCHUYLER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTOUR FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14865-0829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-535-7165
Provider Business Practice Location Address Fax Number:
607-535-2511
Provider Enumeration Date:
11/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUNNINGHAM
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
607-535-7165

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  670-F-004 , 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: 01432402 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02655489 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".