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NPI Code Detail

MEDICARE: FORT HUDSON CERTIFIED HOME HEALTH AGENCY, INC.

MEDICARE: FORT HUDSON CERTIFIED HOME HEALTH AGENCY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1639511892
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT HUDSON CERTIFIED HOME HEALTH AGENCY, INC.
Provider Business Mailing Address
First Line : 319 BROADWAY
Second Line :
City : FORT EDWARD
State : NY
Zip : 12828-1221
Country : US
Telephone Number : 518-747-2811
Fax Number : 518-747-2740
Provider Business Practice Location Address
First Line : 319 BROADWAY
Second Line :
City : FORT EDWARD
State : NY
Zip : 12828-1221
Country : US
Telephone Number : 518-747-2811
Fax Number : 518-747-2740
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MR. JOHN WILLIAM COBURN
Credential :
Telephone Number : 518-747-2811
Provider Enumeration Date : 07/29/2013
Last Update Date : 07/29/2013

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