Provider Demographics
NPI:1326135237
Name:DELAWARE COUNTY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:DELAWARE COUNTY COMMUNITY SERVICES
Other - Org Name:DELAWARE COUNTY ALCOHOL & DRUG ABUSE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-832-5694
Mailing Address - Street 1:243 DELAWARE STREET
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856
Mailing Address - Country:US
Mailing Address - Phone:607-832-5888
Mailing Address - Fax:607-832-6081
Practice Address - Street 1:243 DELAWARE STREET
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856
Practice Address - Country:US
Practice Address - Phone:607-832-5888
Practice Address - Fax:607-832-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03094093Medicaid