1821272972 NPI number — CAYUGA HOME FOR CHILDREN

Table of content: (NPI 1821272972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821272972 NPI number — CAYUGA HOME FOR CHILDREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAYUGA HOME FOR CHILDREN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821272972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HAMILTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13021-5028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HAMILTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13021-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-253-5383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAIMARES
Authorized Official First Name:
FRANJESKA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAID LIAISON
Authorized Official Telephone Number:
646-906-4796

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105754605 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105754602 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105754603 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02997542 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250566894 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105754604 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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