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Organization Active NPI

County of Sullivan

Doing business as Sullivan County Department of Community Services

  • Community/Behavioral Health Agency
  • Liberty, NY
National Provider Identifier
1417987165
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
COUNTY OF SULLIVAN
Doing business as
Sullivan County Department of Community Services
Practice address
20 Community Lane
Liberty, NY 12754-0716
Phone
(845) 292-8770
Fax
(845) 513-2111
NPI assigned
Jul 4, 2006
Last updated
Jul 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Salif Banse, DSW, MSW
Title
Director
Phone
(845) 292-8770

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Mental Health Counselor 101YM0800X
Social Worker 104100000X
Case Management Agency 251B00000X
Clinic/Center 261Q00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

20 Community Lane
Liberty, NY 12754-0716

Mailing address

PO Box 716
20 Community Lane
Liberty, NY 12754-0716
Phone (845) 292-8770

Other identifiers 5

IdentifierTypeStateIssuer
01147777MedicaidNY
143247OtherNYVALUE OPTIONS
12443OtherNYBEACON HEALTH
00398370MedicaidNY
143247OtherNYGHI

Other names 1

  • Sullivan County Department of Community Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040209000841 NY Part B Supplier - Clinic/Group Practice 0143114439 Receives reassigned benefits from 2 practitioners
Practice locations: Liberty, NY

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
M Lavian7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

20 Community Ln
Liberty, NY 12754
Phone (845) 292-8770

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sullivan County Adult Care CenterLiberty, NY, CCN 335628 Skilled nursing facility Operational/Managerial Control (100%)
Adp of the SNF		 Jan 1, 1957
May 5, 1992
County of SullivanLiberty, NY, CCN 337165 Home health agency Operational/Managerial Control (100%) Jul 19, 2010

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1417987165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 716",
            "address_2": "20 COMMUNITY LANE",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127540716",
            "telephone_number": "845-292-8770",
            "fax_number": "845-513-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 COMMUNITY LANE",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127540716",
            "telephone_number": "845-292-8770",
            "fax_number": "845-513-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SULLIVAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "BANSE",
        "authorized_official_first_name": "SALIF",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "845-292-8770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DSW, MSW"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01147777",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "143247",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH",
            "identifier": "12443",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00398370",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "143247",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sullivan County Department of Community Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, NY

Sources for this page

Verify at the official NPI Registry.