Provider Demographics
NPI:1255479390
Name:COUNTY OF WAYNE
Entity Type:Organization
Organization Name:COUNTY OF WAYNE
Other - Org Name:WAYNE COUNTY DRUG & ALCOHOL COMMISSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DRUG & ALCOHOL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLERICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-253-6022
Mailing Address - Street 1:318 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1919
Mailing Address - Country:US
Mailing Address - Phone:570-253-6022
Mailing Address - Fax:
Practice Address - Street 1:318 10TH ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1919
Practice Address - Country:US
Practice Address - Phone:570-253-6022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA647013251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA647013OtherDEPT OF HEALTH LICENSE NO