Provider Demographics
NPI:1578827754
Name:PARTNERS IN HEALING
Entity Type:Organization
Organization Name:PARTNERS IN HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:GAVIN
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BC, BHSP
Authorized Official - Phone:716-548-6190
Mailing Address - Street 1:159 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4827
Mailing Address - Country:US
Mailing Address - Phone:716-548-6190
Mailing Address - Fax:
Practice Address - Street 1:229 MAIN ST
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4915
Practice Address - Country:US
Practice Address - Phone:716-548-6190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268088163WP0808X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty