Healthcare Provider Details

I. General information

NPI: 1093854564
Provider Name (Legal Business Name): COUNTY OF OTSEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 PHOENIX MILLS CROSS RD
COOPERSTOWN NY
13326-5716
US

IV. Provider business mailing address

128 PHOENIX MILLS CROSS RD
COOPERSTOWN NY
13326-5716
US

V. Phone/Fax

Practice location:
  • Phone: 607-544-2684
  • Fax: 607-544-2716
Mailing address:
  • Phone: 607-544-2684
  • Fax: 607-544-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3824901L
License Number StateNY

VIII. Authorized Official

Name: MARY REITZ
Title or Position: DIRECTOR OF PATIENT SERVICES
Credential: RN
Phone: 607-544-2684