=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750593539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNING COUNCIL FOR ASSISTANCE AND INFORMATION FOR THE DISABLED INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 10/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 271 EAST FIRST ST
-----------------------------------------------------
City | CORNING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-962-8225
-----------------------------------------------------
Fax | 607-962-2592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 271 EAST FIRST ST
-----------------------------------------------------
City | CORNING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-962-8225
-----------------------------------------------------
Fax | 607-962-2592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCE DIRECTOR
-----------------------------------------------------
Name | RENE LYNN VANDEWARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-962-8225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 01657203
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------