Healthcare Provider Details

I. General information

NPI: 1447318662
Provider Name (Legal Business Name): CHENANGO COUNTY CATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 OHARA DR
NORWICH NY
13815-2046
US

IV. Provider business mailing address

3 OHARA DR
NORWICH NY
13815-2046
US

V. Phone/Fax

Practice location:
  • Phone: 607-334-8244
  • Fax: 607-336-5779
Mailing address:
  • Phone: 607-334-8244
  • Fax: 607-336-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. DEBORAH RANDALL KING
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 607-334-8244