Provider Demographics
NPI:1043708761
Name:SOUTHERN TIER CONNECT, LLC.
Entity type:Organization
Organization Name:SOUTHERN TIER CONNECT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:W
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:HARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-286-7171
Mailing Address - Street 1:105 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-6175
Mailing Address - Country:US
Mailing Address - Phone:607-286-7171
Mailing Address - Fax:607-238-5705
Practice Address - Street 1:5588 STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2081
Practice Address - Country:US
Practice Address - Phone:607-286-7171
Practice Address - Fax:607-238-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty