Provider Demographics
NPI:1700420304
Name:FAMILY PROMISE OF WAYNE COUNTY
Entity Type:Organization
Organization Name:FAMILY PROMISE OF WAYNE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-359-0850
Mailing Address - Street 1:72 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-1123
Mailing Address - Country:US
Mailing Address - Phone:315-359-0850
Mailing Address - Fax:
Practice Address - Street 1:72 BROAD ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-1123
Practice Address - Country:US
Practice Address - Phone:315-359-0850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty