1396863445 NPI number — ALCOHOL & DRUG DEPENDENCY SERVICES, INC.

Table of content: (NPI 1396863445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396863445 NPI number — ALCOHOL & DRUG DEPENDENCY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALCOHOL & DRUG DEPENDENCY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396863445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
291 ELM STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-854-2977
Provider Business Mailing Address Fax Number:
716-854-2039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-854-2977
Provider Business Practice Location Address Fax Number:
716-854-3293
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARDICK
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
716-854-2997

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  090411448 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 050410478 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 070610167 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 061110163 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 070410164 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 080410651 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 070910477 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 080111248 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 08045448 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X , with the licence number: 070410478 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00-689-703 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000818000 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8406733 . This is a "INDEPENDENT HEALTH-IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00011265201 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 075003-000 . This is a "MBC- GREEN SPRINGS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 075003-000 . This is a "MERIT BEHAVIORAL CARE-CMG" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 075003-000 . This is a "MBC-MEGELLIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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