Organization
ERIE COUNTY SOUTH EAST CORP V
Active
Other names
Spectrum Human Services
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE C NISBET (EXECUTIVE DIRECTOR)
(716) 662-2040
Entity
Organization
Contact information
Practice address
326 ORCHARD PARK RD, WEST SENECA, NY 14224-2635
(716) 662-6638
(716) 823-0751
Mailing address
227 THORN AVE, ORCHARD PARK, NY 14127-2600
(716) 662-2040
(716) 662-0019
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6845102D
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001122770
UNIVERA MH
NY
01
—
000507634001
BCBS - MH
NY
05
—
00660577
—
NY
01
—
040727000154
MED.MANCARE MH & CD
NY
01
—
8401220
IHA - MH & CD
NY
Enumeration date
05/30/2006
Last updated
07/18/2016
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