Provider Demographics
NPI:1093985293
Name:LIVINGSTON-WYOMING ARC
Entity Type:Organization
Organization Name:LIVINGSTON-WYOMING ARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LENNOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-658-2828
Mailing Address - Street 1:18 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1036
Mailing Address - Country:US
Mailing Address - Phone:585-658-2828
Mailing Address - Fax:
Practice Address - Street 1:18 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1036
Practice Address - Country:US
Practice Address - Phone:585-658-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No347B00000XTransportation ServicesBus
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1779455Medicaid
NY2425203Medicaid
NY1490688Medicaid
NY2002326Medicaid
NY2704754Medicaid
NY2267009Medicaid
NY2516301Medicaid
NY00923946Medicaid
NY2043667Medicaid
NY2149640Medicaid
NY2169193Medicaid
NY2603487Medicaid
NY2749668Medicaid
NY2088315Medicaid
NY2513486Medicaid