Provider Demographics
NPI:1447318662
Name:CHENANGO COUNTY CATHOLIC CHARITIES
Entity type:Organization
Organization Name:CHENANGO COUNTY CATHOLIC CHARITIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-334-8244
Mailing Address - Street 1:3 OHARA DR
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-2046
Mailing Address - Country:US
Mailing Address - Phone:607-334-8244
Mailing Address - Fax:607-336-5779
Practice Address - Street 1:3 OHARA DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-2046
Practice Address - Country:US
Practice Address - Phone:607-334-8244
Practice Address - Fax:607-336-5779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-04
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251V00000X, 261QM0850X, 261QM0855X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01303979Medicaid
NY200055623OtherMOHAWK VALLEY PLAN
NY314554OtherVALUE OPTIONS
NY01303979Medicaid