Provider Demographics
NPI:1871978585
Name:BABY B.A.C.K. INC.
Entity type:Organization
Organization Name:BABY B.A.C.K. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-424-6080
Mailing Address - Street 1:107 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2108
Mailing Address - Country:US
Mailing Address - Phone:315-424-6080
Mailing Address - Fax:315-424-6080
Practice Address - Street 1:107 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2108
Practice Address - Country:US
Practice Address - Phone:315-424-6080
Practice Address - Fax:315-424-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NY251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable