Provider Demographics
NPI:1770927451
Name:ELMIRA PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:ELMIRA PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OR OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHANIE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:607-707-4700
Mailing Address - Street 1:100 WASHINGTON STREET
Mailing Address - Street 2:ELMIRA PSYCHIATRIC CENTER
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901
Mailing Address - Country:US
Mailing Address - Phone:607-739-3581
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON STREET
Practice Address - Street 2:ELMIRA PSYCHIATRIC CENTER
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-739-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NYSOMH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital