Provider Demographics
NPI:1962745323
Name:COUNTY OF STEUBEN
Entity type:Organization
Organization Name:COUNTY OF STEUBEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-664-2438
Mailing Address - Street 1:3 E PULTENEY SQ
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1510
Mailing Address - Country:US
Mailing Address - Phone:607-664-2438
Mailing Address - Fax:
Practice Address - Street 1:3 E PULTENEY SQ
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1510
Practice Address - Country:US
Practice Address - Phone:607-664-2438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF STEUBEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-03
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2113L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health