Provider Demographics
NPI:1750593539
Name:CORNING COUNCIL FOR ASSISTANCE AND INFORMATION FOR THE DISABLED INC
Entity type:Organization
Organization Name:CORNING COUNCIL FOR ASSISTANCE AND INFORMATION FOR THE DISABLED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VANDEWARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-962-8225
Mailing Address - Street 1:271 EAST FIRST ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830
Mailing Address - Country:US
Mailing Address - Phone:607-962-8225
Mailing Address - Fax:607-962-2592
Practice Address - Street 1:271 EAST FIRST ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830
Practice Address - Country:US
Practice Address - Phone:607-962-8225
Practice Address - Fax:607-962-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-10-30
Deactivation Date:2008-06-26
Deactivation Code:
Reactivation Date:2012-10-30
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NY01657203251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01657203Medicaid