Provider Demographics
NPI:1790019297
Name:BUFFALO ATHLETIC CLUB EASTERN HILLS
Entity Type:Organization
Organization Name:BUFFALO ATHLETIC CLUB EASTERN HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-631-3800
Mailing Address - Street 1:4687 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6022
Mailing Address - Country:US
Mailing Address - Phone:716-631-3800
Mailing Address - Fax:
Practice Address - Street 1:4687 TRANSIT ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-631-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)