Provider Demographics
NPI:1821284480
Name:PATHFINDER VILLAGE, INC
Entity Type:Organization
Organization Name:PATHFINDER VILLAGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-965-8377
Mailing Address - Street 1:3 CHENANGO ROAD
Mailing Address - Street 2:
Mailing Address - City:EDMESTON
Mailing Address - State:NY
Mailing Address - Zip Code:13335
Mailing Address - Country:US
Mailing Address - Phone:607-965-8377
Mailing Address - Fax:607-965-8655
Practice Address - Street 1:3 CHENANGO ROAD
Practice Address - Street 2:
Practice Address - City:EDMESTON
Practice Address - State:NY
Practice Address - Zip Code:13335
Practice Address - Country:US
Practice Address - Phone:607-965-8377
Practice Address - Fax:607-965-8655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493493251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02248346Medicaid
NY02004548Medicaid