Healthcare Provider Details

I. General information

NPI: 1053239574
Provider Name (Legal Business Name): TIOGA COUNTY HOMELESS INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 CHARLESTON RD
MANSFIELD PA
16933-8806
US

IV. Provider business mailing address

2580 CHARLESTON RD
MANSFIELD PA
16933-8806
US

V. Phone/Fax

Practice location:
  • Phone: 570-724-9001
  • Fax: 570-948-2112
Mailing address:
  • Phone: 570-724-9001
  • Fax: 570-948-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL JEAN THORBORG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 570-724-9001