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NPI Code Detail

MEDICARE: CHILDREN'S HOME OF JEFFERSON COUNTY

MEDICARE: CHILDREN'S HOME OF JEFFERSON COUNTY
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
1251B00000XCase Management Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770625527
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S HOME OF JEFFERSON COUNTY
Provider Business Mailing Address
First Line : PO BOX 6550
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-6550
Country : US
Telephone Number : 315-777-9747
Fax Number : 315-785-5637
Provider Business Practice Location Address
First Line : 211 JB WISE PL
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2507
Country : US
Telephone Number : 315-779-1507
Fax Number :
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : MICHELLE LYNN MONNAT
Credential : LMHC
Telephone Number : 315-777-9747
Provider Enumeration Date : 02/12/2007
Last Update Date : 07/08/2024

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Directions to “CHILDREN'S HOME OF JEFFERSON COUNTY ” Practice Location

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