Basic Information
| Provider Information | |||||||||
| NPI: | 1891907507 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BESTSELF BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 DELAWARE AVENUE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142022017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168420440 | ||||||||
| FaxNumber: | 7168424069 | ||||||||
| Practice Location | |||||||||
| Address1: | 3176 ABBOTT RD UNIT 500 | ||||||||
| Address2: | |||||||||
| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141271069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168822117 | ||||||||
| FaxNumber: | 7168424069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | WOIKE-GANGA | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 7168420440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW-R | ||||||||
| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | N | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | 261QR0405X | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
ID Information
| ID | Type | State | Issuer | Description | 00671765 | 05 | NY | MEDICAID |