Provider Demographics
NPI:1376671974
Name:TIOGA COUNTY
Entity Type:Organization
Organization Name:TIOGA COUNTY
Other - Org Name:TIOGA CO. EARLY INTERVENTION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-687-8604
Mailing Address - Street 1:1062 STATE RTE 38
Mailing Address - Street 2:P.O. BOX 120
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827
Mailing Address - Country:US
Mailing Address - Phone:607-687-8632
Mailing Address - Fax:
Practice Address - Street 1:1062 STATE RTE 38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827
Practice Address - Country:US
Practice Address - Phone:607-687-8632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIOGA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-02
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5324200R251300000X, 251B00000X
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00321866Medicaid