Healthcare Provider Details

I. General information

NPI: 1750593539
Provider Name (Legal Business Name): CORNING COUNCIL FOR ASSISTANCE AND INFORMATION FOR THE DISABLED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date: 06/26/2008
Reactivation Date: 10/30/2012

III. Provider practice location address

271 EAST FIRST ST
CORNING NY
14830
US

IV. Provider business mailing address

271 EAST FIRST ST
CORNING NY
14830
US

V. Phone/Fax

Practice location:
  • Phone: 607-962-8225
  • Fax: 607-962-2592
Mailing address:
  • Phone: 607-962-8225
  • Fax: 607-962-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number01657203
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RENE LYNN VANDEWARK
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 607-962-8225