Organization
WITNESS CARES, LLC
Active
Other names
Witness CARES, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DETRIC D JOHNSON CASE MANAGEMENT (PRESIDENT)
(716) 302-4137
Entity
Organization
Contact information
Practice address
ELM AND CARLTON ST, BUFFALO, NY 14263-0001
(716) 302-4137
(716) 845-3511
Mailing address
535 WYOMING AVE STE A, BUFFALO, NY 14215-3137
(716) 302-4137
(716) 845-3511
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
WC02122020
—
NY
Enumeration date
02/12/2020
Last updated
02/12/2020
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