NPIMap

Organization Active NPI

Baker Victory Services

  • Mental Illness Community Based Residential Treatment Facility
  • Lackawanna, NY
National Provider Identifier
1083867204
Registry record updated Oct 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
F335624-1 Issued in NY
Legal business name
BAKER VICTORY SERVICES
Practice address
790 Ridge Rd
Lackawanna, NY 14218-1629
Phone
(716) 828-9811
NPI assigned
Oct 31, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael Edbauer, D.O.
Title
Medical Director
Phone
(716) 828-9357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X F335624-1 NY Primary

Addresses

Primary practice location

790 Ridge Rd
Lackawanna, NY 14218-1629

Mailing address

790 Ridge Rd
Lackawanna, NY 14218-1629
Phone (716) 828-9811

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225411200000",
    "number": "1083867204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 RIDGE RD",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181629",
            "telephone_number": "716-828-9811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 RIDGE RD",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181629",
            "telephone_number": "716-828-9811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAKER VICTORY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-31",
        "last_updated": "2008-10-31",
        "status": "A",
        "authorized_official_last_name": "EDBAUER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "716-828-9357",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NY",
            "license": "F335624-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lackawanna, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.