Healthcare Provider Details

I. General information

NPI: 1972157469
Provider Name (Legal Business Name): YATES COUNTY CHAPTER NYSARC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 NORTH AVE
PENN YAN NY
14527-1051
US

IV. Provider business mailing address

235 NORTH AVE
PENN YAN NY
14527-1051
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-7447
  • Fax: 315-536-3281
Mailing address:
  • Phone: 315-536-7447
  • Fax: 315-536-3281

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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE RIBBLE
Title or Position: REVENUE ACCOUNTANT
Credential:
Phone: 315-536-7447