Healthcare Provider Details

I. General information

NPI: 1255765608
Provider Name (Legal Business Name): LORD OF LIFE ADULT & CHILD SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BORDEN RD
DEPEW NY
14043-4604
US

IV. Provider business mailing address

1025 BORDEN RD
DEPEW NY
14043-4604
US

V. Phone/Fax

Practice location:
  • Phone: 716-668-8000
  • Fax: 716-668-8058
Mailing address:
  • Phone: 716-668-8000
  • Fax: 716-668-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberNOLICENSE
License Number StateNY

VIII. Authorized Official

Name: ANDREA CASTLE-BAECKER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 716-668-8000