Provider Demographics
NPI:1912279266
Name:WESTERN NEW YORK HEALTHCARE COLLABORATIVE COUNCIL INCORPORATED
Entity Type:Organization
Organization Name:WESTERN NEW YORK HEALTHCARE COLLABORATIVE COUNCIL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOMBA COLLINS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-359-2390
Mailing Address - Street 1:5561 WOODSEDGE CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2848
Mailing Address - Country:US
Mailing Address - Phone:716-359-2390
Mailing Address - Fax:
Practice Address - Street 1:5561 WOODSEDGE CT
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2848
Practice Address - Country:US
Practice Address - Phone:716-359-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health