Healthcare Provider Details

I. General information

NPI: 1124143615
Provider Name (Legal Business Name): TIOGA COUNTY DEPT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1873 SHUMWAY HILL RD
WELLSBORO PA
16901-6840
US

IV. Provider business mailing address

1873 SHUMWAY HILL RD
WELLSBORO PA
16901-6840
US

V. Phone/Fax

Practice location:
  • Phone: 570-724-5766
  • Fax: 570-724-6036
Mailing address:
  • Phone: 570-724-5766
  • Fax: 570-724-6757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MAX HARRISON
Title or Position: ADMINISTRATOR
Credential:
Phone: 570-724-5766