Provider Demographics
NPI:1275903650
Name:MEALS ON WHEELS OF WESTERN BROOME, INC.
Entity Type:Organization
Organization Name:MEALS ON WHEELS OF WESTERN BROOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-754-7856
Mailing Address - Street 1:705 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4521
Mailing Address - Country:US
Mailing Address - Phone:607-754-7856
Mailing Address - Fax:607-821-0868
Practice Address - Street 1:705 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4521
Practice Address - Country:US
Practice Address - Phone:607-754-7856
Practice Address - Fax:607-821-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable