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General NPI Number Information
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NPI Number | 1376899336
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Entity Type | Organization
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Legal Business Name | COVENANT HUMAN SERVICES WNY
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 95 WAKEFIELD AVE
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City | BUFFALO
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State | NY
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Zip | 14214-2111
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Country | US
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Telephone | 716-464-7057
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Fax | 716-464-7057
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Provider Business Mailing Address
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Address Line | 95 WAKEFIELD AVE P.O BOX 821 BUFFALO NY 14215
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City | BUFFALO
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State | NY
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Zip | 14214-2111
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Country | US
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Telephone | 716-464-7057
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Fax | 716-464-7057
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. TRACY YOLANDA HUNT
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Credential | BS, MS
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Telephone | 716-464-7057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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