Provider Demographics
NPI:1285774083
Name:COUNTY OF NIAGARA
Entity type:Organization
Organization Name:COUNTY OF NIAGARA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-439-7410
Mailing Address - Street 1:1001 ELEVENTH STREET
Mailing Address - Street 2:ROOM 172 TROTT ACCESS CENTER
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-278-8110
Mailing Address - Fax:716-278-8111
Practice Address - Street 1:1001 ELEVENTH STREET
Practice Address - Street 2:ROOM 172 TROTT ACCESS CENTER
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-278-8110
Practice Address - Fax:716-278-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000879000OtherBLUE CROSS BLUE SHIELD CB
NY00820457Medicaid
8408706OtherINDEPENDENT HEALTH