Provider Demographics
NPI:1245543610
Name:CHAUTAUQUA COUNTY DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:CHAUTAUQUA COUNTY DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:E.I. SERVICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-753-4786
Mailing Address - Street 1:7 N ERIE ST
Mailing Address - Street 2:HALL R. CLOTHIER BUILDING
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-1090
Mailing Address - Country:US
Mailing Address - Phone:716-753-4312
Mailing Address - Fax:
Practice Address - Street 1:7 N ERIE ST
Practice Address - Street 2:HALL R. CLOTHIER BUILDING
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-1090
Practice Address - Country:US
Practice Address - Phone:716-753-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY490281251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management