Provider Demographics
NPI:1427267806
Name:WESTERN NEW YORK INDEPENDENT LIVING, INC.
Entity type:Organization
Organization Name:WESTERN NEW YORK INDEPENDENT LIVING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:USIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-836-0822
Mailing Address - Street 1:3108 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1306
Mailing Address - Country:US
Mailing Address - Phone:716-836-0822
Mailing Address - Fax:716-835-3967
Practice Address - Street 1:3108 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1362
Practice Address - Country:US
Practice Address - Phone:716-836-0822
Practice Address - Fax:716-835-3967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02005934Medicaid
NY02407789Medicaid
NY06275736Medicaid