Provider Demographics
NPI:1063151751
Name:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC.
Entity type:Organization
Organization Name:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVILEGING & CREDENTIALING SPECIAL
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEILS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-787-8151
Mailing Address - Street 1:601B W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2119
Mailing Address - Country:US
Mailing Address - Phone:315-781-8448
Mailing Address - Fax:
Practice Address - Street 1:112 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1816
Practice Address - Country:US
Practice Address - Phone:315-536-2752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-01
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)