Provider Demographics
NPI:1114122306
Name:TIOGA COUNTY
Entity Type:Organization
Organization Name:TIOGA COUNTY
Other - Org Name:TIOGA COUNTY DEPARTMENT OF MENTAL HYGIENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:607-687-0200
Mailing Address - Street 1:1062 STATE ROUTE 38
Mailing Address - Street 2:PO BOX 177
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827
Mailing Address - Country:US
Mailing Address - Phone:607-687-0200
Mailing Address - Fax:607-687-0248
Practice Address - Street 1:1062 STATE ROUTE 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827
Practice Address - Country:US
Practice Address - Phone:607-687-0200
Practice Address - Fax:607-687-0248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIOGA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-18
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6893100AOtherNYSOMH OPER. CERT. NO.
NY6893100BOtherNYSOMH OPER. CERT. NO.
NY00618162Medicaid
NY6893100BOtherNYSOMH OPER. CERT. NO.