Provider Demographics
NPI:1750716148
Name:CATTARAUGUS COUNTY DEPARTMENT OF THE AGING
Entity type:Organization
Organization Name:CATTARAUGUS COUNTY DEPARTMENT OF THE AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AGING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MACKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-701-3226
Mailing Address - Street 1:1 LEO MOSS DR
Mailing Address - Street 2:SUITE 7610
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LEO MOSS DR
Practice Address - Street 2:SUITE 7610
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1101
Practice Address - Country:US
Practice Address - Phone:716-701-8032
Practice Address - Fax:716-701-3730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATTARAUGUS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02704603Medicaid