Provider Demographics
NPI:1669695391
Name:BAKER HALL
Entity type:Organization
Organization Name:BAKER HALL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/COO
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARZYCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-828-9751
Mailing Address - Street 1:790 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218-1629
Mailing Address - Country:US
Mailing Address - Phone:716-828-9751
Mailing Address - Fax:716-828-9450
Practice Address - Street 1:790 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218-1629
Practice Address - Country:US
Practice Address - Phone:716-828-9700
Practice Address - Fax:716-828-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7577120A251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6307336OtherINDEPENDENT HEALTH
00011307201OtherUNIVERA HEALTHCARE
NY0005120761OtherBLUE CROSS OF WNY
NY01101413Medicaid