Provider Demographics
NPI:1780878371
Name:HORIZON VILLAGE RECOVERY CENTER
Entity type:Organization
Organization Name:HORIZON VILLAGE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R DEPARTMENT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADRIANE
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:BROCZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-831-1800
Mailing Address - Street 1:3020 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2814
Mailing Address - Country:US
Mailing Address - Phone:716-831-1800
Mailing Address - Fax:716-831-1818
Practice Address - Street 1:314 ELLICOTT ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3650
Practice Address - Country:US
Practice Address - Phone:585-815-0247
Practice Address - Fax:585-815-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health