Healthcare Provider Details

I. General information

NPI: 1962916460
Provider Name (Legal Business Name): UCPA OF NIAGARA COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 LOCKPORT RD
NIAGARA FALLS NY
14304-1114
US

IV. Provider business mailing address

9812 LOCKPORT RD
NIAGARA FALLS NY
14304-1114
US

V. Phone/Fax

Practice location:
  • Phone: 716-297-0798
  • Fax: 716-297-0998
Mailing address:
  • Phone: 716-297-0798
  • Fax: 716-297-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NANCY J MANGUS
Title or Position: BUDGET MANAGER
Credential:
Phone: 716-297-0798