Provider Demographics
NPI:1588851455
Name:TOWN OF CHERRY VALLEY
Entity Type:Organization
Organization Name:TOWN OF CHERRY VALLEY
Other - Org Name:TOWN OF CHERRY VALLEY/COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERVISOR-TOWN OF CHERRY VALLEY
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:GARRETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-264-9045
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:2 MAIN STREET
Mailing Address - City:CHERRY VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13320
Mailing Address - Country:US
Mailing Address - Phone:607-264-3036
Mailing Address - Fax:607-264-9326
Practice Address - Street 1:2 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHERRY VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13320
Practice Address - Country:US
Practice Address - Phone:607-264-3036
Practice Address - Fax:607-264-9326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF CHERRY VALLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-25
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330064-1261QR1300X
NYF330039-1261QR1300X
3821202R261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473538Medicaid
NY00473538Medicaid
NY333805Medicare UPIN
NY333805Medicare PIN