Provider Demographics
NPI:1629240312
Name:NYSARC INC., CHEMUNG COUNTY CHAPTER
Entity Type:Organization
Organization Name:NYSARC INC., CHEMUNG COUNTY CHAPTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:RANIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-734-6151
Mailing Address - Street 1:711 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2322
Mailing Address - Country:US
Mailing Address - Phone:607-734-6151
Mailing Address - Fax:607-734-2943
Practice Address - Street 1:711 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2322
Practice Address - Country:US
Practice Address - Phone:607-734-6151
Practice Address - Fax:607-734-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00926572Medicaid