MEDICARE: WASHINGTON COUNTY OFA

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1730548702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON COUNTY OFA

Provider Business Mailing Address
First Line	:	383 BROADWAY
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1001
Country	:	US
Telephone Number	:	518-746-2421
Fax Number	:

Provider Business Practice Location Address
First Line	:	383 BROADWAY
Second Line	:
City	:	FORT EDWARD
State	:	NY
Zip	:	12828-1001
Country	:	US
Telephone Number	:	518-746-2421
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. GINA CANTNUCCI-MITCHELL
Credential	:
Telephone Number	:	518-746-2421

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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