Provider Demographics
NPI:1063685188
Name:WAYNE COUNTY COMMUNITY ORGANIZATION
Entity Type:Organization
Organization Name:WAYNE COUNTY COMMUNITY ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-429-0070
Mailing Address - Street 1:3609 HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704-1952
Mailing Address - Country:US
Mailing Address - Phone:304-429-0070
Mailing Address - Fax:
Practice Address - Street 1:3609 HUGHES STEET
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1952
Practice Address - Country:US
Practice Address - Phone:304-429-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030797002Medicaid