Provider Demographics
NPI:1194380964
Name:CHENANGO VALLEY ADULT ENRICHMENT CENTER
Entity Type:Organization
Organization Name:CHENANGO VALLEY ADULT ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:VICTORIA-MAE
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-334-6598
Mailing Address - Street 1:24 CANASAWACTA ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1623
Mailing Address - Country:US
Mailing Address - Phone:607-334-6598
Mailing Address - Fax:607-336-6625
Practice Address - Street 1:14 CANASAWACTA ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1623
Practice Address - Country:US
Practice Address - Phone:607-334-6598
Practice Address - Fax:607-336-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care