Provider Demographics
NPI:1801880083
Name:COUNTY OF FULTON
Entity type:Organization
Organization Name:COUNTY OF FULTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-773-3400
Mailing Address - Street 1:847 COUNTY HIGHWAY 122
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-6413
Mailing Address - Country:US
Mailing Address - Phone:518-773-3444
Mailing Address - Fax:518-725-7582
Practice Address - Street 1:847 COUNTY HIGHWAY 122
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-6413
Practice Address - Country:US
Practice Address - Phone:518-773-3444
Practice Address - Fax:518-725-7582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FULTON (PARENT ORGANIZATION) FULTON COUNTY NURSING SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-02
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1701600251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1701600Medicaid
NY00439583Medicaid
NY337074Medicare Oscar/Certification
NY337074Medicare PIN