Provider Demographics
NPI:1003274788
Name:AWAIT RSA
Entity Type:Organization
Organization Name:AWAIT RSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:443-851-1348
Mailing Address - Street 1:5900 YORK RD
Mailing Address - Street 2:215
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3041
Mailing Address - Country:US
Mailing Address - Phone:410-433-1264
Mailing Address - Fax:
Practice Address - Street 1:5900 YORK RD
Practice Address - Street 2:215
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3041
Practice Address - Country:US
Practice Address - Phone:410-433-1264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3798251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health