Provider Demographics
NPI:1962622118
Name:COMMUNITY MISSIONS OF NIAGARA FRONTIER, INC.
Entity type:Organization
Organization Name:COMMUNITY MISSIONS OF NIAGARA FRONTIER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATHALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-285-3403
Mailing Address - Street 1:1570 BUFFALO AVENUE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-1516
Mailing Address - Country:US
Mailing Address - Phone:716-285-3403
Mailing Address - Fax:716-285-0616
Practice Address - Street 1:1570 BUFFALO AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-1516
Practice Address - Country:US
Practice Address - Phone:716-285-3403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY MISSIONS OF NIAGARA FRONTIER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-30
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01432879Medicaid