Provider Demographics
NPI:1255460390
Name:NIAGARA COUNTY HEALTH DEPARTMENT
Entity type:Organization
Organization Name:NIAGARA COUNTY HEALTH DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CHILDREN W/ SPECIAL NEEDS
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:716-278-1991
Mailing Address - Street 1:1001 11TH ST
Mailing Address - Street 2:TROTT ACCESS CENTER
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1201
Mailing Address - Country:US
Mailing Address - Phone:716-278-1991
Mailing Address - Fax:716-278-8288
Practice Address - Street 1:1001 11TH ST
Practice Address - Street 2:TROTT ACCESS CENTER
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1201
Practice Address - Country:US
Practice Address - Phone:716-278-1991
Practice Address - Fax:716-278-8288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIAGARA COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474951Medicaid