Provider Demographics
NPI:1740232479
Name:INTERIM HEALTHCARE OF BINGHAMTON, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF BINGHAMTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:V
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS RN
Authorized Official - Phone:607-722-6461
Mailing Address - Street 1:38 FRONT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4712
Mailing Address - Country:US
Mailing Address - Phone:607-722-6461
Mailing Address - Fax:607-771-0116
Practice Address - Street 1:38 FRONT ST
Practice Address - Street 2:SUITE D
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4712
Practice Address - Country:US
Practice Address - Phone:607-722-6461
Practice Address - Fax:607-771-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9668L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02404855Medicaid
NY00809710Medicaid
NY00590354Medicaid
NY01206073Medicaid
NY02156792Medicaid
NY01206073Medicaid