Provider Demographics
NPI:1275683203
Name:CONSUMER SERVICES OF MADISON COUNTY
Entity Type:Organization
Organization Name:CONSUMER SERVICES OF MADISON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANLIESHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-363-2451
Mailing Address - Street 1:1099 NORTHSIDE SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-4901
Mailing Address - Country:US
Mailing Address - Phone:315-363-2451
Mailing Address - Fax:315-363-2454
Practice Address - Street 1:1099 NORTHSIDE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-4901
Practice Address - Country:US
Practice Address - Phone:315-363-2451
Practice Address - Fax:315-363-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02140710Medicaid