Provider Demographics
NPI:1609830819
Name:WAONE INC
Entity Type:Organization
Organization Name:WAONE INC
Other - Org Name:FAMILY HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ALTOMARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-339-4049
Mailing Address - Street 1:121 EAST FIFTH STREEET
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851
Mailing Address - Country:US
Mailing Address - Phone:570-339-4049
Mailing Address - Fax:570-339-1643
Practice Address - Street 1:121 EAST FIFTH STREEET
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851
Practice Address - Country:US
Practice Address - Phone:570-339-4049
Practice Address - Fax:570-339-1643
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NCS HOME MED INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-14
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012689060001Medicaid
397512Medicare ID - Type Unspecified