Provider Demographics
NPI:1013976513
Name:AVALON CENTERS, INC.
Entity type:Organization
Organization Name:AVALON CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:BOESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-839-0999
Mailing Address - Street 1:346 HARRIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7407
Mailing Address - Country:US
Mailing Address - Phone:716-839-0999
Mailing Address - Fax:716-839-2058
Practice Address - Street 1:346 HARRIS HILL RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7407
Practice Address - Country:US
Practice Address - Phone:716-839-0999
Practice Address - Fax:716-839-2058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9255320A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00030010901OtherUNIVERA
NY050505000054OtherFIDELIS
NY8090017OtherINDEPENDENT HEALTH
NY000526352001OtherBLUE CROSS BLUE SHIELD
NY7340621OtherGHI