Provider Demographics
NPI:1194702506
Name:WYOMING COUNTY
Entity type:Organization
Organization Name:WYOMING COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORCIMIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-786-8940
Mailing Address - Street 1:400 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1025
Mailing Address - Country:US
Mailing Address - Phone:585-786-2233
Mailing Address - Fax:585-786-1222
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1025
Practice Address - Country:US
Practice Address - Phone:585-786-2233
Practice Address - Fax:585-786-1222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYOMING COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-28
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6027000N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314085Medicaid
NY000000128000OtherBLUE CROSS WESTERN NY
NY95OtherEXCELLUS BLUE CROSS
NY000000128000OtherBLUE CROSS WESTERN NY