Provider Demographics
NPI:1689710154
Name:ENCOMPASS HEALTH HOME, LLC
Entity Type:Organization
Organization Name:ENCOMPASS HEALTH HOME, LLC
Other - Org Name:CATHOLIC CHARITIES MH
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-729-9166
Mailing Address - Street 1:232 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-729-9166
Mailing Address - Fax:607-729-5601
Practice Address - Street 1:232 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2610
Practice Address - Country:US
Practice Address - Phone:607-729-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01164149Medicaid