Organization
SOUTHERN TIER INDEPENDENCE CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER WATSON (ASSISTANT DIRECTOR)
(607) 724-2111
Entity
Organization
Contact information
Practice address
135 E FREDERICK ST, BINGHAMTON, NY 13904-1224
(607) 724-2111
Mailing address
135 E FREDERICK ST, BINGHAMTON, NY 13904-1224
(607) 724-2111
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
251X00000X
Supports Brokerage Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01489734
—
NY
05
—
01543122
—
NY
05
—
01741166
—
NY
05
—
02003001
—
NY
05
—
02168761
—
NY
05
—
02516310
—
NY
05
—
02625478
—
NY
05
—
02693649
—
NY
Enumeration date
05/16/2007
Last updated
07/12/2019
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