Healthcare Provider Details

I. General information

NPI: 1083618672
Provider Name (Legal Business Name): BUFFALO BEACON CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3354 SHERIDAN DR
AMHERST NY
14226-1439
US

IV. Provider business mailing address

3354 SHERIDAN DR
AMHERST NY
14226-1439
US

V. Phone/Fax

Practice location:
  • Phone: 716-831-1937
  • Fax: 716-831-8837
Mailing address:
  • Phone: 716-831-1937
  • Fax: 716-831-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number170912042
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number050610689
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01183233
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: MRS. JACQUELINE L WEST
Title or Position: CHIEF OPERATING OFFICER
Credential: MBA, CASAC
Phone: 716-831-1937