Healthcare Provider Details

I. General information

NPI: 1063638930
Provider Name (Legal Business Name): WARREN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 STATE ROUTE 9 MUNICIPAL CENTER
LAKE GEORGE NY
12845-3434
US

IV. Provider business mailing address

1340 STATE ROUTE 9 MUNICIPAL CENTER
LAKE GEORGE NY
12845-3434
US

V. Phone/Fax

Practice location:
  • Phone: 518-761-6415
  • Fax: 518-761-6562
Mailing address:
  • Phone: 518-761-6415
  • Fax: 518-761-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5620901L
License Number StateNY

VIII. Authorized Official

Name: GINELLE JONES
Title or Position: DIRECTOR
Credential: FNP
Phone: 518-761-6580