Provider Demographics
NPI:1689990632
Name:GREATER BINGHAMTON HEALTH CENTER
Entity Type:Organization
Organization Name:GREATER BINGHAMTON HEALTH CENTER
Other - Org Name:COMMUNITY TREATMENT AND RECOVERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-763-2722
Mailing Address - Street 1:425 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1735
Mailing Address - Country:US
Mailing Address - Phone:607-763-2722
Mailing Address - Fax:
Practice Address - Street 1:425 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1735
Practice Address - Country:US
Practice Address - Phone:607-763-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness