Provider Demographics
NPI:1578539607
Name:WYOMING COUNTY COUNTY OF WYOMING
Entity Type:Organization
Organization Name:WYOMING COUNTY COUNTY OF WYOMING
Other - Org Name:CERTIFIED HOME HEALTH AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF NRUSING
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:585-786-8838
Mailing Address - Street 1:5362 MUNGERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14550-9704
Mailing Address - Country:US
Mailing Address - Phone:585-786-8838
Mailing Address - Fax:585-786-8840
Practice Address - Street 1:5362 MUNGERS MILL RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14550-9704
Practice Address - Country:US
Practice Address - Phone:585-786-8838
Practice Address - Fax:585-786-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6027600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8351463OtherINDEPENDENT HEALTH
NYP0101050WWOtherBLUE CHOICE ROCHESTER
NY00011247402OtherUNIVERA PPO
NYWWOtherBLUE CROSS ROCHESTER
NY00011247401OtherUNIVERA
NY00356107Medicaid
NY103334C1OtherPREFERRED CARE
NY00356107Medicaid