Provider Demographics
NPI:1437745841
Name:FINGER LAKES COORDINATION & CARE
Entity Type:Organization
Organization Name:FINGER LAKES COORDINATION & CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-898-0215
Mailing Address - Street 1:107 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1611
Mailing Address - Country:US
Mailing Address - Phone:607-898-0215
Mailing Address - Fax:607-397-5864
Practice Address - Street 1:107 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903-1611
Practice Address - Country:US
Practice Address - Phone:607-898-0215
Practice Address - Fax:607-397-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05769544Medicaid
NY05769535Medicaid