Provider Demographics
NPI:1134127251
Name:EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:EARLY INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FEUERHERM
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:607-753-5135
Mailing Address - Street 1:60 CENTRAL AVE
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:607-753-5135
Mailing Address - Fax:607-753-5209
Practice Address - Street 1:60 CENTRAL AVE
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:607-753-5135
Practice Address - Fax:607-753-5209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORTLAND COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474240Medicaid