Healthcare Provider Details

I. General information

NPI: 1063425643
Provider Name (Legal Business Name): CHENANGO MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 01/03/2022
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 N BROAD ST
NORWICH NY
13815-1019
US

IV. Provider business mailing address

179 N BROAD ST
NORWICH NY
13815-1019
US

V. Phone/Fax

Practice location:
  • Phone: 607-337-4111
  • Fax:
Mailing address:
  • Phone: 607-337-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0824000N
License Number StateNY

VIII. Authorized Official

Name: DR. DRAKE LAMEN
Title or Position: PRESIDENT & CEO
Credential: M.D.
Phone: 607-337-4113