Provider Demographics
NPI:1861946154
Name:TRACTORHEALTHSOLUTIONS LLC
Entity type:Organization
Organization Name:TRACTORHEALTHSOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW R
Authorized Official - Phone:6467-249-5767
Mailing Address - Street 1:243 BAYARD STREET
Mailing Address - Street 2:# 724
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466
Mailing Address - Country:US
Mailing Address - Phone:646-249-5767
Mailing Address - Fax:
Practice Address - Street 1:243 BAYARD STREET
Practice Address - Street 2:# 724
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466
Practice Address - Country:US
Practice Address - Phone:646-249-5767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080579171M00000X, 1041C0700X
NY23700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03589764Medicaid
NYA40010968Medicare Oscar/Certification