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NPI Code Detail

MEDICARE: LAKE SHORE BEHAVIORAL HEALTH

MEDICARE: LAKE SHORE BEHAVIORAL HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1487973426
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE SHORE BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 255 DELAWARE AVE STE 300
Second Line :
City : BUFFALO
State : NY
Zip : 14202-2016
Country : US
Telephone Number : 716-842-0440
Fax Number :
Provider Business Practice Location Address
First Line : 255 DELAWARE AVE
Second Line : SUITE 300
City : BUFFALO
State : NY
Zip : 14202-2016
Country : US
Telephone Number : 716-842-0440
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. HOWARD K HITZEL
Credential :
Telephone Number : 716-842-0440
Provider Enumeration Date : 05/28/2010
Last Update Date : 05/28/2010

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Directions to “LAKE SHORE BEHAVIORAL HEALTH ” Practice Location

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