BAKER VICTORY SERVICES (NPI# 1083867204) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083867204 |
| Entity Type | Organization |
| Organization Name | BAKER VICTORY SERVICES |
| Practice Address |
790 Ridge Rd Lackawanna NY 14218-1629 |
| Practice Telephone | 7168289811 |
| Mailing Telephone | 7168289811 |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2008-10-31 |
| Authorized Official Name | DR. MICHAEL EDBAUER (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 7168289357 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | F335624-1 | NY | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447461876 | Baker Victory Services | Nursing Facility/Intermediate Care Facility | 180 Martin Road, Lackawanna, NY 14218 | 2007-05-25 |
| 1396956462 | Baker Victory Services | Psychiatric Residential Treatment Facility | 150 Martin Road, Lackawanna, NY 14218 | 2007-05-24 |
| 1205047370 | Baker Victory Services | Nursing Facility/Intermediate Care Facility | 150 Martin Road, Lackawanna, NY 14218 | 2007-05-24 |
| 1114138286 | Baker Victory Services | Nursing Facility/Intermediate Care Facility | 150 Martin Road, Lackawanna, NY 14218 | 2007-05-24 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BAKER VICTORY SERVICES | 790 Ridge Rd, Buffalo, NY 14218-1629 |
| Street Address |
790 RIDGE RD |
| City | LACKAWANNA |
| State | NY |
| Zip Code | 14218-1629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669539029 | Daniel Mangold | Psychiatry & Neurology | 790 Ridge Rd, Baker Victory Services, D. Mangold, M.d., Lackawanna, NY 14218-1629 | 2007-01-03 |
| 1881203669 | Dawn Gayadeen | Counselor | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2020-07-28 |
| 1518514678 | Dawn Marie Luniewski | Occupational Therapist | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2019-08-23 |
| 1760959407 | Jordan Toles | Peer Specialist | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2018-10-31 |
| 1427533975 | Bianca Scott-malone | Case Manager/Care Coordinator | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2018-10-01 |
| 1932684016 | Karen Dwyer | Community Health Worker | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2018-09-25 |
| 1487138830 | Kevin Chapman Chapman | Community Health Worker | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2018-09-21 |
| 1790269652 | Taryn Wilde | Community Health Worker | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2018-09-17 |
| 1740764695 | Bryan Buchanan | Community Health Worker | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2018-09-17 |
| 1346724291 | Marium Ashraf | Community Health Worker | 790 Ridge Rd, Lackawanna, NY 14218-1629 | 2018-09-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811419765 | Jennifer Lynn Cuneo | Nurse Practitioner | 20 Maryknoll Dr, Lackawanna, NY 14218 | 2017-07-12 |
| 1144579251 | Jennifer Jalil-contreras | Social Worker | 33 Wilkesbarre Avenue, Lackawanna, NY 14218 | 2012-09-05 |
| 1578833323 | Buffalo Synapse Support, LLC | Specialist/Technologist, Other | 609 Ridge Road, Lackawanna, NY 14218 | 2012-01-11 |
| 1851546097 | Rania Karam-bayoumi | Family Medicine | 227 Ridge Road, Lackawanna, NY 14218 | 2008-12-01 |
| 1548427552 | Jennifer Anne Molea | Specialist | 1025 Ridge Road, Lackawanna, NY 14218 | 2008-05-19 |
| 1649481904 | Richard Edwin Zambron | Dentist | 1243 Ridge Road, Lackawanna, NY 14218 | 2007-05-25 |
| 1447461876 | Baker Victory Services | Nursing Facility/Intermediate Care Facility | 180 Martin Road, Lackawanna, NY 14218 | 2007-05-25 |
| 1396956462 | Baker Victory Services | Psychiatric Residential Treatment Facility | 150 Martin Road, Lackawanna, NY 14218 | 2007-05-24 |
| 1245352921 | Baker Hall | Day Training, Developmentally Disabled Services | 650 Ridge Road, Lackawanna, NY 14218 | 2007-04-04 |
| 1730210238 | Brandi Arcara | Counselor | 2600 South Park Avenue, Parkview Center, Lackawanna, NY 14218 | 2007-03-08 |
| Find all providers in zip 14218 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922661784 | Greater Horizons, House Inc. | Community Based Residential Treatment Facility, Mental Illness | 25 Indian Rd Apt 6f, New York, NY 10034-1018 | 2019-04-17 |
| 1013474113 | Hope House On Crotona Park, LLC | Community Based Residential Treatment Facility, Mental Illness | 853 Crotona Park N, Bronx, NY 10460-4701 | 2019-02-25 |
| 1457825135 | Eating Disorder Treatment of New York, LLC | Community Based Residential Treatment Facility, Mental Illness | 1 Saint Andrews Ln, Glen Cove, NY 11542-2221 | 2019-01-16 |
| 1679011530 | Nando Pelusi, Phd | Community Based Residential Treatment Facility, Mental Illness | 305 Hicks Street, 2, Brookyn, NY 11201 | 2017-02-10 |
| 1245684729 | William F Ryan Community Health Center Inc | Community Based Residential Treatment Facility, Mental Illness | 138 W 143rd St, New York, NY 10030-1615 | 2016-04-20 |
| 1205280955 | William F Ryan Community Health Center Inc | Community Based Residential Treatment Facility, Mental Illness | 22 Convent Ave, New York, NY 10027-2604 | 2016-04-19 |
| 1245602838 | Nyeshia Skipwith | Community Based Residential Treatment Facility, Mental Illness | 37 Titmus Dr, Mastic, NY 11950-2011 | 2015-10-22 |
| 1447663067 | 187 Cottage Avenue Corp | Community Based Residential Treatment Facility, Mental Illness | 187 Cottage Ave, Mount Vernon, NY 10550-1446 | 2014-06-11 |
| 1235542135 | Erin Faryna | Community Based Residential Treatment Facility, Mental Illness | 51 Rossler Ave, Cheektowaga, NY 14206-2409 | 2014-06-09 |
| 1508280504 | Advanced Therapeutic Solutions | Community Based Residential Treatment Facility, Mental Illness | 1731 61st St Apt 4, Brooklyn, NY 11204-2219 | 2014-02-11 |
| Find all providers with the same taxonomy | ||||
| City | LACKAWANNA |
| Zip Code | 14218 |
Please comment or provide details below to improve the information on BAKER VICTORY SERVICES.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.