Provider Demographics
NPI:1770649147
Name:CHENANGO COUNTY
Entity Type:Organization
Organization Name:CHENANGO COUNTY
Other - Org Name:PH PREVENT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMIN. SERVICES OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-337-1658
Mailing Address - Street 1:5 COURT ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1695
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 COURT ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1695
Practice Address - Country:US
Practice Address - Phone:607-337-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474635Medicaid
NY03003936Medicaid