MEDICARE: PATHFINDER VILLAGE, 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
1	251V00000X	Voluntary or Charitable Agency	0493493	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1821284480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATHFINDER VILLAGE, INC

Provider Business Mailing Address
First Line	:	3 CHENANGO ROAD
Second Line	:
City	:	EDMESTON
State	:	NY
Zip	:	13335
Country	:	US
Telephone Number	:	607-965-8377
Fax Number	:	607-965-8655

Provider Business Practice Location Address
First Line	:	3 CHENANGO ROAD
Second Line	:
City	:	EDMESTON
State	:	NY
Zip	:	13335
Country	:	US
Telephone Number	:	607-965-8377
Fax Number	:	607-965-8655

Authorized Official
Title or Position	:	CEO
Name	:	EDWARD A SHAFER
Credential	:
Telephone Number	:	607-965-8377

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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