Healthcare Provider Details

I. General information

NPI: 1336635010
Provider Name (Legal Business Name): UCPA OF NIAGARA COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9812 LOCKPORT RD
NIAGARA FALLS NY
14304-1197
US

IV. Provider business mailing address

9812 LOCKPORT RD
NIAGARA FALLS NY
14304-1197
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 Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

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