Provider Demographics
NPI:1417999053
Name:HOSPICE OF THE NORTH COUNTRY, INC
Entity Type:Organization
Organization Name:HOSPICE OF THE NORTH COUNTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-561-8465
Mailing Address - Street 1:358 TOM MILLER ROAD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0000
Mailing Address - Country:US
Mailing Address - Phone:518-561-8465
Mailing Address - Fax:518-561-3182
Practice Address - Street 1:358 TOM MILLER ROAD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-0000
Practice Address - Country:US
Practice Address - Phone:518-561-8465
Practice Address - Fax:518-561-3182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0901501F251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01081745Medicaid
NY01081745Medicaid