Healthcare Provider Details

I. General information

NPI: 1982908117
Provider Name (Legal Business Name): ERIE COUNTY SOUTH EAST CORP V
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 N MAIN ST
WARSAW NY
14569-1326
US

IV. Provider business mailing address

227 THORN AVE BOX 631
ORCHARD PARK NY
14127-2600
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0220
  • Fax: 585-786-3631
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: BRUCE NISBET
Title or Position: PRESIDENT / CEO
Credential:
Phone: 716-662-2040