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General NPI Number Information
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NPI Number | 1104295237
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Entity Type | Organization
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Legal Business Name | BOYS ON THE RIGHT TRACK
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 1597 EVERGREEN DR
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City | LAKE VIEW
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State | NY
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Zip | 14085-9567
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Country | US
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Telephone | 716-316-1789
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Fax |
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Provider Business Mailing Address
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Address Line | 1597 EVERGREEN DR
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City | LAKE VIEW
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State | NY
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Zip | 14085-9567
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Country | US
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Telephone | 716-316-1789
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. JULIET MEADE
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Credential |
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Telephone | 716-316-1789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 251V00000X
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License Number State | NY
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