Provider Demographics
NPI:1730259599
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:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MED, MPA
Authorized Official - Phone:716-439-7430
Mailing Address - Street 1:5467 UPPER MOUNTAIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1854
Mailing Address - Country:US
Mailing Address - Phone:716-278-1991
Mailing Address - Fax:716-278-8288
Practice Address - Street 1:5467 UPPER MOUNTAIN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1854
Practice Address - Country:US
Practice Address - Phone:716-278-1991
Practice Address - Fax:716-278-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430717Medicaid