Healthcare Provider Details

I. General information

NPI: 1922009919
Provider Name (Legal Business Name): COUNTY OF SULLIVAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 COMMUNITY LN
LIBERTY NY
12754-2851
US

IV. Provider business mailing address

50 COMMUNITY LN PO BOX 590
LIBERTY NY
12754-2851
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-5910
  • Fax: 845-513-2276
Mailing address:
  • Phone: 845-292-5910
  • Fax: 845-513-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MS. JILL HUBERT-SIMON
Title or Position: DEPUTY DIRECTOR
Credential: MS
Phone: 845-292-5910