Healthcare Provider Details

I. General information

NPI: 1417589904
Provider Name (Legal Business Name): WITNESS CARES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

535 WYOMING AVE STE A
BUFFALO NY
14215-3137
US

V. Phone/Fax

Practice location:
  • Phone: 716-302-4137
  • Fax: 716-845-3511
Mailing address:
  • Phone: 716-302-4137
  • Fax: 716-845-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DETRIC D JOHNSON
Title or Position: PRESIDENT
Credential: CASE MANAGEMENT
Phone: 716-302-4137