Provider Demographics
NPI:1376899336
Name:COVENANT HUMAN SERVICES WNY
Entity Type:Organization
Organization Name:COVENANT HUMAN SERVICES WNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS
Authorized Official - Phone:716-464-7057
Mailing Address - Street 1:95 WAKEFIELD AVE
Mailing Address - Street 2:P.O BOX 821 BUFFALO NY 14215
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2111
Mailing Address - Country:US
Mailing Address - Phone:716-464-7057
Mailing Address - Fax:716-464-7057
Practice Address - Street 1:95 WAKEFIELD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2111
Practice Address - Country:US
Practice Address - Phone:716-464-7057
Practice Address - Fax:716-464-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251B00000XAgenciesCase Management