Provider Demographics
NPI:1962786780
Name:SUSQUEHANNA HOME HEALTH CARE AGENCY
Entity type:Organization
Organization Name:SUSQUEHANNA HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLL
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRINSKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-729-9206
Mailing Address - Street 1:282 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2727
Mailing Address - Country:US
Mailing Address - Phone:607-729-9206
Mailing Address - Fax:607-797-3229
Practice Address - Street 1:270 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2739
Practice Address - Country:US
Practice Address - Phone:607-729-9206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:282 RIVERSIDE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1305L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health