MEDICARE: ECONOMIC OPPORTUNITY PROGRAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023229473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECONOMIC OPPORTUNITY PROGRAM

Provider Business Mailing Address
First Line	:	650 BALDWIN ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2216
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 BALDWIN ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-2216
Country	:	US
Telephone Number	:	607-734-6174
Fax Number	:

Authorized Official
Title or Position	:	FAMILY DEVELOPMENT DEPUTY DIRECTOR
Name	:	MARYANN BRYANT
Credential	:
Telephone Number	:	607-734-6174

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/22/2020

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Directions to “ECONOMIC OPPORTUNITY PROGRAM ” Practice Location

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