Organization
JEFFERSON COUNTY PUBLIC HEALTH SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORENA LOUISE KIMBALL (ACCOUNTANT)
(315) 786-3742
Entity
Organization
Contact information
Practice address
531 MEADE ST, WATERTOWN, NY 13601-1225
(315) 786-3710
(315) 786-3761
Mailing address
531 MEADE ST, WATERTOWN, NY 13601-1225
(315) 786-3710
(315) 786-3761
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
2201901L
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2201901L
LTHHCP OPERATING CERTIFIC
NY
Enumeration date
01/02/2007
Last updated
08/22/2020
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