Healthcare Provider Details

I. General information

NPI: 1366597171
Provider Name (Legal Business Name): CATHOLIC CHARITIES OF CORTLAND COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 35 CENTRAL AVE
CORTLAND NY
13045-2601
US

IV. Provider business mailing address

33 35 CENTRAL AVE
CORTLAND NY
13045-2601
US

V. Phone/Fax

Practice location:
  • Phone: 607-756-5992
  • Fax: 607-756-5999
Mailing address:
  • Phone: 607-756-5992
  • Fax: 607-756-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIE L WALSH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 607-756-5992