Provider Demographics
NPI:1457402505
Name:LEWIS COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:LEWIS COUNTY GENERAL HOSPITAL
Other - Org Name:LCGH CERTIFIED HOME HEALTH CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-376-5203
Mailing Address - Street 1:7785 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1229
Mailing Address - Country:US
Mailing Address - Phone:315-376-5200
Mailing Address - Fax:315-376-9317
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5200
Practice Address - Fax:315-376-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2424600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00321944Medicaid
NY=========OtherHEALTH CARE PLANS