Baker Victory Healthcare Center
Clinic/Center, Multi-Specialty in Lackawanna, NY. Organization (NPI-2).
NPI number1245095413
StatusActive
Last updated in NPPESMar 25, 2024
Details
- NPI
- 1245095413
- Entity type
- Organization (NPI-2)
- Legal business name
- Baker Victory Healthcare Center
- Organization subpart
- No
- Enumeration date
- Feb 16, 2024
- Certification date
- Mar 25, 2024
- Last updated
- Mar 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – | Yes |
Practice location
790 Ridge Road 2nd FloorLackawanna, NY 14218
Phone 716-828-7586
Mailing address
790 Ridge Road 2nd FloorLackawanna, NY 14218
Phone 716-828-7586
Authorized official
Sheila Rena Hunt
Chief Program Officer
7168289699
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