Healthcare Provider Details

I. General information

NPI: 1497935092
Provider Name (Legal Business Name): ERIE COUNTY SOUTH EAST CORP V
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLUEBIRD SQ
OLEAN NY
14760-2552
US

IV. Provider business mailing address

227 THORN AVE
ORCHARD PARK NY
14127-2600
US

V. Phone/Fax

Practice location:
  • Phone: 716-373-1950
  • Fax: 716-373-1927
Mailing address:
  • Phone: 716-662-2040
  • Fax: 716-662-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AIDA CRUZ
Title or Position: CREDENTIALING & RISK SPECIALIST
Credential:
Phone: 716-539-6737