Provider Demographics
NPI:1881638658
Name:CHILDREN'S HOME OF WYOMING CONFERENCE
Entity Type:Organization
Organization Name:CHILDREN'S HOME OF WYOMING CONFERENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-772-6904
Mailing Address - Street 1:1182 CHENANGO ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1653
Mailing Address - Country:US
Mailing Address - Phone:607-772-6904
Mailing Address - Fax:607-723-2617
Practice Address - Street 1:1182 CHENANGO ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1653
Practice Address - Country:US
Practice Address - Phone:607-772-6904
Practice Address - Fax:607-723-2617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NYRID 1582;2330;2023;251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00353580Medicaid
NY01254562Medicaid