Provider Demographics
NPI:1598751547
Name:ST CATHERINE LABOURE MEDICAL ADULT DAY HEALTHCARE PROGRAM
Entity Type:Organization
Organization Name:ST CATHERINE LABOURE MEDICAL ADULT DAY HEALTHCARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNLOP
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:716-862-2431
Mailing Address - Street 1:2157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2648
Mailing Address - Country:US
Mailing Address - Phone:716-862-1450
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-862-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CATHERINE LABOURE HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01743920Medicaid