Provider Demographics
NPI:1316111636
Name:ALLEGANY COUNTY COMMUNITY SERVICES
Entity type:Organization
Organization Name:ALLEGANY COUNTY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:585-593-1991
Mailing Address - Street 1:45 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1224
Mailing Address - Country:US
Mailing Address - Phone:585-593-1991
Mailing Address - Fax:585-593-7104
Practice Address - Street 1:45 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1224
Practice Address - Country:US
Practice Address - Phone:585-593-1991
Practice Address - Fax:585-593-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01287801Medicaid