Provider Demographics
NPI:1336324409
Name:COUNTY OF ORANGE
Entity Type:Organization
Organization Name:COUNTY OF ORANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM EVALUATION ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-291-2902
Mailing Address - Street 1:30 HARRIMAN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2410
Mailing Address - Country:US
Mailing Address - Phone:845-291-2600
Mailing Address - Fax:845-291-2628
Practice Address - Street 1:30 HARRIMAN DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2410
Practice Address - Country:US
Practice Address - Phone:845-291-2600
Practice Address - Fax:845-291-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03004253Medicaid
NY00542503Medicaid
NYW06181Medicare UPIN