Provider Demographics
NPI:1144387135
Name:JEFFERSON COUNTY PUBLIC HEALTH SERVICE
Entity Type:Organization
Organization Name:JEFFERSON COUNTY PUBLIC HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:DORENA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-786-3742
Mailing Address - Street 1:531 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1225
Mailing Address - Country:US
Mailing Address - Phone:315-786-3710
Mailing Address - Fax:315-786-3761
Practice Address - Street 1:531 MEADE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1225
Practice Address - Country:US
Practice Address - Phone:315-786-3710
Practice Address - Fax:315-786-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2201901L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2201901LOtherLTHHCP OPERATING CERTIFIC
NY2201901LOtherLTHHCP OPERATING CERTIFIC