Organization
PHOENIX FRONTIER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK MANGANELLO (PRESIDENT/CEO)
(716) 833-3231
Entity
Organization
Contact information
Practice address
100 LEROY, BUFFALO, NY 14214
(716) 833-3231
Mailing address
100 LEROY, BUFFALO, NY 14214
(716) 833-3231
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
6075659
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01499949
—
NY
05
—
01509466
—
NY
05
—
01597722
—
NY
05
—
02003092
—
NY
05
—
02155008
—
NY
05
—
02170923
—
NY
05
—
02559364
—
NY
05
—
02617825
—
NY
05
—
02702032
—
NY
Enumeration date
05/02/2008
Last updated
05/02/2008
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