Basic Information
| Provider Information | |||||||||
| NPI: | 1073163531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EHS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 SOUTH ELMWOOD AVE | ||||||||
| Address2: | ATTN JESSICA STACK | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168472441 | ||||||||
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| Address1: | 206 S ELMWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142012398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168472441 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2019 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | STACK | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE CFO | ||||||||
| AuthorizedOfficialTelephone: | 7168470212 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EHS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 02995357 | 05 | NY | MEDICAID |