Healthcare Provider Details

I. General information

NPI: 1114356581
Provider Name (Legal Business Name): TIOGA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 STATE ROUTE 38
OWEGO NY
13827-0120
US

IV. Provider business mailing address

P.O. BOX 120 1062 STATE ROUTE 38
OWEGO NY
13827
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-8600
  • Fax: 607-687-8486
Mailing address:
  • Phone: 607-687-8600
  • Fax: 607-687-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2166L001
License Number StateNY

VIII. Authorized Official

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