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General NPI Number Information
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NPI Number | 1871212290
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Entity Type | Organization
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Legal Business Name | WESTERN NEW YORK INDEPENDENT LIVING, INC.
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 3108 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14214-1362
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Country | US
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Telephone | 716-836-0822
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Fax |
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Provider Business Mailing Address
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Address Line | 3108 MAIN ST
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City | BUFFALO
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State | NY
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Zip | 14214-1362
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Country | US
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Telephone | 716-836-0822
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOUGLAS J USIAK
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Credential |
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Telephone | 716-836-0822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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