Provider Demographics
NPI:1629155445
Name:WYNDHAM HEALTHCARE INC.
Entity Type:Organization
Organization Name:WYNDHAM HEALTHCARE INC.
Other - Org Name:INTEGRITY LIFE CHOICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:PREGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-362-3252
Mailing Address - Street 1:27 S MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17023
Mailing Address - Country:US
Mailing Address - Phone:717-362-3252
Mailing Address - Fax:
Practice Address - Street 1:27 S MARKET STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHVILLE
Practice Address - State:PA
Practice Address - Zip Code:17023
Practice Address - Country:US
Practice Address - Phone:717-362-3252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherHOME HEALTH