Provider Demographics
NPI:1487123451
Name:HEALING WATERS OUTREACH MINISTRIES
Entity type:Organization
Organization Name:HEALING WATERS OUTREACH MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWELL-ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:CERTRECOVERY COACH
Authorized Official - Phone:160-717-6839
Mailing Address - Street 1:1547 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-1632
Mailing Address - Country:US
Mailing Address - Phone:716-725-0561
Mailing Address - Fax:
Practice Address - Street 1:1547 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-1632
Practice Address - Country:US
Practice Address - Phone:716-725-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No177F00000XOther Service ProvidersLodging
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No305S00000XManaged Care OrganizationsPoint of Service