Provider Demographics
NPI:1851420038
Name:WYOMING COUNTY EARLY INTERVENTION
Entity Type:Organization
Organization Name:WYOMING COUNTY EARLY INTERVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-786-8850
Mailing Address - Street 1:8 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1220
Mailing Address - Country:US
Mailing Address - Phone:585-786-8850
Mailing Address - Fax:585-786-8852
Practice Address - Street 1:8 PERRY AVE
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1220
Practice Address - Country:US
Practice Address - Phone:585-786-8850
Practice Address - Fax:585-786-8852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF WYOMING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03002155Medicaid
NY00356074Medicaid