Provider Demographics
NPI:1891725255
Name:COUNTY OF CHENANGO
Entity Type:Organization
Organization Name:COUNTY OF CHENANGO
Other - Org Name:CHENANGO COUNTY ALCOHOL & DRUG ABUSE SERVICES CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:607-337-1600
Mailing Address - Street 1:105 LEILANI'S WAY
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815
Mailing Address - Country:US
Mailing Address - Phone:607-337-1680
Mailing Address - Fax:607-336-1380
Practice Address - Street 1:105 LEILANI'S WAY
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-337-1680
Practice Address - Fax:607-336-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070510713261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00581246Medicaid
NY143232OtherFAMILY HEALTH PLUS
NY=========OtherEXCELLUS