Healthcare Provider Details

I. General information

NPI: 1063562841
Provider Name (Legal Business Name): TIOGA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 STATE RTE. 38
OWEGO NY
13827-3209
US

IV. Provider business mailing address

1062 STATE RTE. 38 P. O. BOX 120
OWEGO NY
13827-3209
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-8573
  • Fax: 607-223-7063
Mailing address:
  • Phone: 607-687-8604
  • Fax: 607-223-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number5320901L
License Number StateNY

VIII. Authorized Official

Name: MR. DENIS MCCANN
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 607-687-8604