Healthcare Provider Details

I. General information

NPI: 1871978585
Provider Name (Legal Business Name): BABY B.A.C.K. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CORNELL AVE
SYRACUSE NY
13207-2108
US

IV. Provider business mailing address

107 CORNELL AVE
SYRACUSE NY
13207-2108
US

V. Phone/Fax

Practice location:
  • Phone: 315-424-6080
  • Fax: 315-424-6080
Mailing address:
  • Phone: 315-424-6080
  • Fax: 315-424-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. GERALD A SEALS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 315-424-6080