Provider Demographics
NPI:1902897374
Name:COUNTY OF CHAUTAUQUA A MUN CORP
Entity Type:Organization
Organization Name:COUNTY OF CHAUTAUQUA A MUN CORP
Other - Org Name:CHAUTAUQUA COUNTY DEPARTMENT OF MENTAL HYGIENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. OF COMM. MENTAL HYGIENE SER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-753-4104
Mailing Address - Street 1:2 ACADEMY ST RM 201
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-1050
Mailing Address - Country:US
Mailing Address - Phone:716-753-4104
Mailing Address - Fax:716-753-4230
Practice Address - Street 1:200 E 3RD ST STE 5
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5433
Practice Address - Country:US
Practice Address - Phone:716-661-8330
Practice Address - Fax:716-661-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
56121AMedicare ID - Type Unspecified
56122AMedicare ID - Type Unspecified