MEDICARE: NORTH COUNTRY HOME SERVICES, INC.

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	251E00000X	Home Health Agency	0113L001	NY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144223322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH COUNTRY HOME SERVICES, INC.

Provider Business Mailing Address
First Line	:	25 CHURCH ST
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1816
Country	:	US
Telephone Number	:	518-891-5611
Fax Number	:	518-891-2055

Provider Business Practice Location Address
First Line	:	25 CHURCH ST
Second Line	:
City	:	SARANAC LAKE
State	:	NY
Zip	:	12983-1816
Country	:	US
Telephone Number	:	518-891-5611
Fax Number	:	518-891-2055

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. REBECCA JOY LEAHY
Credential	:	RN
Telephone Number	:	518-891-5611

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/11/2012

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