MEDICARE: SUSQUEHANNA HOME HEALTH CARE AGENCY

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	1305L001	NY

General Provider Information

NPI Number	:	1962786780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSQUEHANNA HOME HEALTH CARE AGENCY

Provider Business Mailing Address
First Line	:	282 RIVERSIDE DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2727
Country	:	US
Telephone Number	:	607-729-9206
Fax Number	:	607-797-3229

Provider Business Practice Location Address
First Line	:	270 RIVERSIDE DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-2739
Country	:	US
Telephone Number	:	607-729-9206
Fax Number	:

Authorized Official
Title or Position	:	CONTROLL
Name	:	BERNADETTE A BRINSKO
Credential	:
Telephone Number	:	607-729-9206

Provider Enumeration Date	:	09/29/2011
Last Update Date	:	09/29/2011

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