Provider Demographics
NPI:1285639625
Name:OSWEGO HEALTH HOME CARE LLC..
Entity Type:Organization
Organization Name:OSWEGO HEALTH HOME CARE LLC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-349-5531
Mailing Address - Street 1:510 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2951
Mailing Address - Country:US
Mailing Address - Phone:315-598-1544
Mailing Address - Fax:
Practice Address - Street 1:510 S 4TH ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2951
Practice Address - Country:US
Practice Address - Phone:315-598-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSWEGO HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3701600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01238384Medicaid
NY01238384Medicaid