Provider Demographics
NPI:1417012311
Name:COMMUNITY HEALTH CENTER OF ST. MARY'S HEALTHCARE & NATHAN LITTAUER HOS
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER OF ST. MARY'S HEALTHCARE & NATHAN LITTAUER HOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERRITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-762-8215
Mailing Address - Street 1:2-8 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2-8 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2308
Practice Address - Country:US
Practice Address - Phone:518-762-8215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1758601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00873758Medicaid
337205Medicare ID - Type Unspecified