Basic Information
| Provider Information | |||||||||
| NPI: | 1780878371 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HORIZON VILLAGE RECOVERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 BAILEY AVE | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142152814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168311800 | ||||||||
| FaxNumber: | 7168311818 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 ELLICOTT ST | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140203650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5858150247 | ||||||||
| FaxNumber: | 5858150251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 08/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | BROCZKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | ADRIANE | ||||||||
| AuthorizedOfficialMiddleName: | RENE | ||||||||
| AuthorizedOfficialTitleorPosition: | A/R DEPARTMENT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7168311800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | NY | Y | Agencies | Community/Behavioral Health |
No ID Information.