NPIMap

Organization Active NPI

Sullivan County Public Health Services

  • Home Health Agency
  • Liberty, NY
National Provider Identifier
1770639445
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
SULLIVAN COUNTY PUBLIC HEALTH SERVICES
Practice address
50 Community LN
Liberty, NY 12754-2851
Phone
(845) 292-5910
Fax
(845) 513-2276
NPI assigned
Jan 26, 2007
Last updated
Jul 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Authorized official

Name
Ms. Jill Hubert-Simon, MS
Title
Deputy Director
Phone
(845) 292-5910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

50 Community LN
Liberty, NY 12754-2851

Mailing address

50 Community LN
PO Box 590
Liberty, NY 12754-2851
Phone (845) 292-5910

Other identifiers 1

IdentifierTypeStateIssuer
03003165MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100923001059 NY Part A Provider - Home Health Agency 0143114439 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Liberty, NY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770639445. Details of each certification follow.

Home health agency certification: CCN 337165

Legal name
COUNTY OF SULLIVAN
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 23, 1973
Last certification
May 22, 2019
Ownership / control type
Government Operated
Organization structure
GovernmentNon-profit
Enrollment address
50 Community Lane
Liberty, NY 12754-2851

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Sullivan County Public Health Services ChhaCCN 337165 · All quality measures
Overall star rating
3 of 5
Ownership
Government Operated
Certified
Mar 23, 1973
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
County of Sullivan Organization, Monticello, NY Operational/Managerial Control Jul 19, 2010 100%
Tiffany Kahn Individual Corporate DirectorDirector of Patient Services Tra Aug 15, 2024
Joshua Potosek Individual Corporate OfficerCounty Manager Aug 15, 2024
April Novello Individual W-2 Managing EmployeeSupervising Public Health Nurse Aug 12, 2013
Jill Hubert-Simon Individual Corporate DirectorInterim Director Public Health Aug 15, 2024

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 27

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1770639445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 COMMUNITY LN",
            "address_2": "PO BOX 590",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127542851",
            "telephone_number": "845-292-5910",
            "fax_number": "845-513-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 COMMUNITY LN",
            "city": "LIBERTY",
            "state": "NY",
            "postal_code": "127542851",
            "telephone_number": "845-292-5910",
            "fax_number": "845-513-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN COUNTY PUBLIC HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "HUBERT-SIMON",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "845-292-5910",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03003165",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, NY

Sources for this page

Verify at the official NPI Registry.