Healthcare Provider Details

I. General information

NPI: 1497948657
Provider Name (Legal Business Name): NIAGARA HOME SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 E BRITTON DR
NIAGARA FALLS NY
14304-1322
US

IV. Provider business mailing address

7480 E BRITTON DR
NIAGARA FALLS NY
14304-1322
US

V. Phone/Fax

Practice location:
  • Phone: 716-297-8585
  • Fax: 716-297-3283
Mailing address:
  • Phone: 716-297-8585
  • Fax: 716-297-3283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1380L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number1380L001
License Number StateNY

VIII. Authorized Official

Name: MR. RALPH SPINA
Title or Position: ADMINISTRATOR
Credential:
Phone: 716-297-8585