Provider Demographics
NPI:1033368949
Name:CORTLAND COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CORTLAND COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAILOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:607-753-5038
Mailing Address - Street 1:60 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2746
Mailing Address - Country:US
Mailing Address - Phone:607-753-5038
Mailing Address - Fax:607-753-5029
Practice Address - Street 1:60 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2746
Practice Address - Country:US
Practice Address - Phone:607-753-5038
Practice Address - Fax:607-753-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1101600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02843823Medicaid