Provider Demographics
NPI:1588015432
Name:WAYNE COUNTY ACTION PROGRAM, INC.
Entity Type:Organization
Organization Name:WAYNE COUNTY ACTION PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-665-0131
Mailing Address - Street 1:159 MONTEZUMA ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-1228
Mailing Address - Country:US
Mailing Address - Phone:315-665-0131
Mailing Address - Fax:315-665-0137
Practice Address - Street 1:159 MONTEZUMA ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-1228
Practice Address - Country:US
Practice Address - Phone:315-665-0131
Practice Address - Fax:315-665-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health