Provider Demographics
NPI:1336651314
Name:CARE COORDINATION PARTNERS OF UPSTATE NY, LLC
Entity Type:Organization
Organization Name:CARE COORDINATION PARTNERS OF UPSTATE NY, LLC
Other - Org Name:PRIME CARE COORDINATION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-329-3977
Mailing Address - Street 1:860 HARD RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8825
Mailing Address - Country:US
Mailing Address - Phone:585-329-3977
Mailing Address - Fax:
Practice Address - Street 1:860 HARD RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8825
Practice Address - Country:US
Practice Address - Phone:585-329-3977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management