Provider Demographics
NPI:1699170613
Name:OFFICE OF MENTAL HEALTH
Entity type:Organization
Organization Name:OFFICE OF MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMHN
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKPERHIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:716-816-2960
Mailing Address - Street 1:400 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1207
Mailing Address - Country:US
Mailing Address - Phone:716-816-2445
Mailing Address - Fax:
Practice Address - Street 1:400 FOREST AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1207
Practice Address - Country:US
Practice Address - Phone:716-816-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22680061310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness