Provider Demographics
NPI:1396863445
Name:ALCOHOL & DRUG DEPENDENCY SERVICES, INC.
Entity Type:Organization
Organization Name:ALCOHOL & DRUG DEPENDENCY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARDICK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:716-854-2997
Mailing Address - Street 1:291 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:716-854-2977
Mailing Address - Fax:716-854-2039
Practice Address - Street 1:291 ELM ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-854-2977
Practice Address - Fax:716-854-3293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090411448324500000X
NY050410478324500000X
NY070610167324500000X
NY061110163324500000X
NY070410164324500000X
NY080410651324500000X
NY070910477324500000X
NY080111248324500000X
NY08045448324500000X
NY070410478324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00-689-703Medicaid
NY000000818000OtherBLUE CROSS & BLUE SHIELD
NY8406733OtherINDEPENDENT HEALTH-IHA
NY00011265201OtherUNIVERA
NY075003-000OtherMBC- GREEN SPRINGS
NY075003-000OtherMERIT BEHAVIORAL CARE-CMG
NY075003-000OtherMBC-MEGELLIN
NY=========OtherN. AMERICAN HEALTH PLAN
NY=========OtherNOVA
NY=========OtherUNITED HEALTH CARE
NY=========OtherFIDELIS
NY=========OtherVALUE BEHAVIORAL HEALTH
NY8406733OtherINDEPENDENT HEALTH-IHA
NY=========OtherGHI GROUP HEALTH INC.
NY075003-000OtherMERIT BEHAVIORAL CARE-CMG
NY00-689-703Medicaid
NY00011265201OtherUNIVERA
NY075003-000OtherMBC- GREEN SPRINGS