Organization
BAKER VICTORY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL EDBAUER D.O. (MEDICAL DIRECTOR)
(716) 828-9357
Entity
Organization
Contact information
Practice address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 828-9811
Mailing address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 828-9811
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
F335624-1
NY
Other
Enumeration date
10/31/2008
Last updated
10/31/2008
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