Provider Demographics
NPI:1144223322
Name:NORTH COUNTRY HOME SERVICES, INC.
Entity Type:Organization
Organization Name:NORTH COUNTRY HOME SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:518-891-5611
Mailing Address - Street 1:25 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1816
Mailing Address - Country:US
Mailing Address - Phone:518-891-5611
Mailing Address - Fax:518-891-2055
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1816
Practice Address - Country:US
Practice Address - Phone:518-891-5611
Practice Address - Fax:518-891-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0113L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00891736Medicaid
NY01293030Medicaid