NPI 1083867204

Baker Victory Services

Organisation Mental Illness Community Based Residential Treatment Facility Lackawanna, NY

Practice location

Address: 790 Ridge Rd, Lackawanna, NY 14218-1629
Phone: (716) 828-9811

Authorised official

Name: Michael Edbauer
Title: Medical Director
Phone: (716) 828-9357

Registered specialties

Mental Illness Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320800000X Licence F335624-1 (NY)

Other Community Based Residential Treatment Facility, Mental Illness providers in New York →

Registry record

NPI: 1083867204
Entity type: Organization
NPI issued: 31 Oct 2008
Record last updated: 31 Oct 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.