Provider Demographics
NPI:1699250696
Name:ONONDAGA CASE MANAGEMENT SERVICES INC.
Entity type:Organization
Organization Name:ONONDAGA CASE MANAGEMENT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-472-7363
Mailing Address - Street 1:620 ERIE BLVD W STE 302
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2463
Mailing Address - Country:US
Mailing Address - Phone:315-593-4061
Mailing Address - Fax:
Practice Address - Street 1:620 ERIE BLVD W STE 302
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2463
Practice Address - Country:US
Practice Address - Phone:315-593-4061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02994838Medicaid