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Organization
SUPPLEMENTAL PROFESSIONAL RESOURCES, INC.
Active
Organization
SUPPLEMENTAL PROFESSIONAL RESOURCES, INC.
Active
Other names
Niagara Home Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD L KEPNER (CHIEF FINANCIAL OFFICER)
(716) 514-5527
Entity
Organization
Contact information
Practice address
3976 LOCKPORT OLCOTT RD, LOCKPORT, NY 14094-1133
(716) 433-7810
(716) 433-7811
Mailing address
3976 LOCKPORT OLCOTT RD, LOCKPORT, NY 14094-1133
(716) 433-7810
(716) 433-7811
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
9969L001
NY
332B00000X
Durable Medical Equipment & Medical Supplies
9969L001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011340201
UNIVERA BILLING #
NY
01
—
000551258001
BCBS BILLING #
NY
05
—
01779735
—
NY
05
—
01879616
—
NY
01
—
8210096
IHA BILLING #
NY
Enumeration date
10/10/2005
Last updated
09/11/2025
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