| Western New York Independent Living, Inc. | |
|
3108 Main St Buffalo NY 14214-1362 | |
| (716) 836-0822 | |
| Not Available |
| Full Name | Western New York Independent Living, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3108 Main St, Buffalo, New York |
| Authorized Official Name and Position | Douglas J Usiak (CEO) |
| Authorized Official Contact | 7168360822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western New York Independent Living, Inc. 3108 Main St Buffalo NY 14214-1362 Ph: (716) 836-0822 | Western New York Independent Living, Inc. 3108 Main St Buffalo NY 14214-1362 Ph: (716) 836-0822 |
| NPI Number | 1871212290 |
|---|---|
| Provider Enumeration Date | 08/29/2022 |
| Last Update Date | 10/06/2022 |
| Certification Date | 10/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871212290 | NPI | - | NPPES |
| 02005934 | Medicaid | NY | |
| 06275736 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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