Healthcare Provider Details

I. General information

NPI: 1508562661
Provider Name (Legal Business Name): HEART OF CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 LASALLE AVE APT 314
BUFFALO NY
14214-1452
US

IV. Provider business mailing address

89 LASALLE AVE APT 314
BUFFALO NY
14214-1452
US

V. Phone/Fax

Practice location:
  • Phone: 716-424-6694
  • Fax: 716-261-2719
Mailing address:
  • Phone: 716-424-6694
  • Fax: 716-261-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW PAULK
Title or Position: CEO
Credential:
Phone: 716-424-6694