Provider Demographics
NPI:1760733026
Name:FINGER LAKES INDEPENDENCE CENTER
Entity Type:Organization
Organization Name:FINGER LAKES INDEPENDENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-272-2433
Mailing Address - Street 1:215 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3403
Mailing Address - Country:US
Mailing Address - Phone:607-272-2433
Mailing Address - Fax:607-272-0902
Practice Address - Street 1:215 5TH ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3403
Practice Address - Country:US
Practice Address - Phone:607-272-2433
Practice Address - Fax:607-272-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01776461Medicaid