Healthcare Provider Details

I. General information

NPI: 1093985293
Provider Name (Legal Business Name): LIVINGSTON-WYOMING ARC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MAIN ST
MOUNT MORRIS NY
14510-1036
US

IV. Provider business mailing address

18 MAIN ST
MOUNT MORRIS NY
14510-1036
US

V. Phone/Fax

Practice location:
  • Phone: 585-658-2828
  • Fax:
Mailing address:
  • Phone: 585-658-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347B00000X
TaxonomyBus
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN LENNOX
Title or Position: ACCOUNTING MANAGER
Credential:
Phone: 585-658-2828