Provider Demographics
NPI:1013363787
Name:COMPASSIONATE CARE OF NIAGARA INC
Entity Type:Organization
Organization Name:COMPASSIONATE CARE OF NIAGARA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LAVONIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-524-2498
Mailing Address - Street 1:755 DORWOOD PARK
Mailing Address - Street 2:
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131-9672
Mailing Address - Country:US
Mailing Address - Phone:716-524-2498
Mailing Address - Fax:716-524-2504
Practice Address - Street 1:1122 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1260
Practice Address - Country:US
Practice Address - Phone:716-524-2498
Practice Address - Fax:716-524-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04344548Medicaid