Healthcare Provider Details

I. General information

NPI: 1487123451
Provider Name (Legal Business Name): HEALING WATERS OUTREACH MINISTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 GENESEE ST
BUFFALO NY
14211-1632
US

IV. Provider business mailing address

1547 GENESEE ST
BUFFALO NY
14211-1632
US

V. Phone/Fax

Practice location:
  • Phone: 716-725-0561
  • Fax:
Mailing address:
  • Phone: 716-725-0561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. BENITA HOWELL-ISRAEL
Title or Position: MANAGING DIRECTOR
Credential: CERT.RECOVERY COACH
Phone: 160-717-6839