Provider Demographics
NPI:1063509909
Name:COUNTY OF WAYNE
Entity Type:Organization
Organization Name:COUNTY OF WAYNE
Other - Org Name:WAYNE COUNTY PUBLIC HEALTH SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEVLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN, ANP
Authorized Official - Phone:315-946-5749
Mailing Address - Street 1:1519 NYE RD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489
Mailing Address - Country:US
Mailing Address - Phone:315-946-5749
Mailing Address - Fax:315-946-5762
Practice Address - Street 1:1519 NYE RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489
Practice Address - Country:US
Practice Address - Phone:315-946-5749
Practice Address - Fax:315-946-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355413Medicaid