Provider Demographics
NPI:1558486571
Name:TIOGA COUNTY DEPT OF HUMAN SERVICES
Entity Type:Organization
Organization Name:TIOGA COUNTY DEPT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-724-5766
Mailing Address - Street 1:1873 SHUMWAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-6840
Mailing Address - Country:US
Mailing Address - Phone:570-724-5766
Mailing Address - Fax:570-724-6757
Practice Address - Street 1:1873 SHUMWAY HILL RD
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6840
Practice Address - Country:US
Practice Address - Phone:570-724-5766
Practice Address - Fax:570-724-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000000400036Medicaid