=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093975583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROOME COUNTY HEALTH DEPARTMENT-LHCSA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2008
-----------------------------------------------------
Last Update Date | 04/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 FRONT ST.
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-778-2802
-----------------------------------------------------
Fax | 607-778-2864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 FRONT ST.
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-778-2802
-----------------------------------------------------
Fax | 607-778-2864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PUBLIC HEALTH DIRECTOR
-----------------------------------------------------
Name | MRS. CLAUDIA EDWARDS
-----------------------------------------------------
Credential | MS BS
-----------------------------------------------------
Telephone | 607-778-2802
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 0938L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------