Healthcare Provider Details

I. General information

NPI: 1215278577
Provider Name (Legal Business Name): CORTLAND COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KENNEDY PKWY
CORTLAND NY
13045-1409
US

IV. Provider business mailing address

11 KENNEDY PKWY
CORTLAND NY
13045-1409
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-9105
  • Fax:
Mailing address:
  • Phone: 607-753-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number623451
License Number StateNY

VIII. Authorized Official

Name: MARY BEACH
Title or Position: DIRECTOR
Credential:
Phone: 607-753-9105