Provider Demographics
NPI:1821095902
Name:HOSPICE OF CHENANGO COUNTY, INC.
Entity Type:Organization
Organization Name:HOSPICE OF CHENANGO COUNTY, INC.
Other - Org Name:HOSPICE & PALLIATIVE CARE OF CHENANGO COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OUTHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MA
Authorized Official - Phone:607-334-3556
Mailing Address - Street 1:21 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1617
Mailing Address - Country:US
Mailing Address - Phone:607-334-3556
Mailing Address - Fax:607-334-3688
Practice Address - Street 1:21 HAYES ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1617
Practice Address - Country:US
Practice Address - Phone:607-334-3556
Practice Address - Fax:607-334-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0824500F251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01268400Medicaid
NY331548Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER