Provider Demographics
NPI:1073730909
Name:JEFFERSON COUNTY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:JEFFERSON COUNTY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EI & PK COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LJUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:CVETKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-785-3283
Mailing Address - Street 1:175 ARSENAL ST FL 5
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2528
Mailing Address - Country:US
Mailing Address - Phone:315-785-3283
Mailing Address - Fax:315-785-5182
Practice Address - Street 1:175 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2528
Practice Address - Country:US
Practice Address - Phone:315-785-3283
Practice Address - Fax:315-785-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00583711Medicaid