Provider Demographics
NPI:1659860815
Name:VALUE NETWORK LLC IPA
Entity Type:Organization
Organization Name:VALUE NETWORK LLC IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:COLEMAN
Authorized Official - Last Name:NISBET
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:716-539-5329
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-0631
Mailing Address - Country:US
Mailing Address - Phone:716-539-5329
Mailing Address - Fax:716-662-2040
Practice Address - Street 1:227 THORN AVE
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2600
Practice Address - Country:US
Practice Address - Phone:716-539-5329
Practice Address - Fax:716-662-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health