Provider Demographics
NPI:1407163686
Name:ERIE COUNTY SOUTH EAST CORP V
Entity Type:Organization
Organization Name:ERIE COUNTY SOUTH EAST CORP V
Other - Org Name:SPECTRUM HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NISBET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-662-2040
Mailing Address - Street 1:227 THORN AVE
Mailing Address - Street 2:BOX 631
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2600
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:58 W BUFFALO
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-2600
Practice Address - Country:US
Practice Address - Phone:585-786-5551
Practice Address - Fax:585-786-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY076341Medicare PIN