Healthcare Provider Details

I. General information

NPI: 1225918345
Provider Name (Legal Business Name): JERICHO ROAD MINISTRIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 BARTON ST
BUFFALO NY
14213-1573
US

IV. Provider business mailing address

184 BARTON ST
BUFFALO NY
14213-1573
US

V. Phone/Fax

Practice location:
  • Phone: 716-881-6191
  • Fax: 716-881-6247
Mailing address:
  • Phone: 716-881-6191
  • Fax: 716-881-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JACKIE ENDRESS
Title or Position: CREDENTIALING SPECIALIST
Credential: CREDENTIALING
Phone: 716-348-3000