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General NPI Number Information
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NPI Number | 1376890798
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Entity Type | Organization
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Legal Business Name | ERIE COUNTY SOUTHEAST CORP V
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 505 DELAWARE AVE
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City | BUFFALO
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State | NY
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Zip | 14202-1309
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Country | US
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Telephone | 716-662-2040
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Fax | 716-662-0019
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Provider Business Mailing Address
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Address Line | BOX 631 227 THORN AVENUE
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City | ORCHARD PARK
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State | NY
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Zip | 14202
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Country | US
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Telephone | 716-662-2040
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Fax | 716-662-0019
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Authorized Official
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Title or Position | PRESIDENT./CEO
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Name | BRUCE C. NISBET
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Credential |
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Telephone | 716-662-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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