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General NPI Number Information
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NPI Number | 1730548702
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Entity Type | Organization
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Legal Business Name | WASHINGTON COUNTY OFA
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 383 BROADWAY
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City | FORT EDWARD
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State | NY
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Zip | 12828-1001
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Country | US
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Telephone | 518-746-2421
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Fax |
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Provider Business Mailing Address
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Address Line | 383 BROADWAY
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City | FORT EDWARD
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State | NY
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Zip | 12828-1001
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Country | US
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Telephone | 518-746-2421
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. GINA CANTNUCCI-MITCHELL
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Credential |
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Telephone | 518-746-2421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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