Provider Demographics
NPI:1457484495
Name:WAYNE COUNTY COMMUNITY SERVICE ORG., INC.
Entity Type:Organization
Organization Name:WAYNE COUNTY COMMUNITY SERVICE ORG., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
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:25704-1915
Mailing Address - Country:US
Mailing Address - Phone:304-429-0070
Mailing Address - Fax:304-429-0026
Practice Address - Street 1:3609 HUGHES ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-1915
Practice Address - Country:US
Practice Address - Phone:304-429-0070
Practice Address - Fax:304-429-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030797002Medicaid
WV0030797000Medicaid
WV0030797001Medicaid
WV0030797003Medicaid