Provider Demographics
NPI:1497820971
Name:WAYNE COUNTY HOME CARE AIDE AGENCY
Entity Type:Organization
Organization Name:WAYNE COUNTY HOME CARE AIDE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-872-2012
Mailing Address - Street 1:100 E SOUTH ST
Mailing Address - Street 2:P.O. BOX 25
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-1724
Mailing Address - Country:US
Mailing Address - Phone:641-872-2012
Mailing Address - Fax:641-872-2012
Practice Address - Street 1:100 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1724
Practice Address - Country:US
Practice Address - Phone:641-872-2012
Practice Address - Fax:641-872-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5885CO93251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0077131Medicaid