Provider Demographics
NPI:1710296421
Name:CHEMUNG ARC
Entity Type:Organization
Organization Name:CHEMUNG ARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
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:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services