Provider Demographics
NPI:1811035199
Name:COUNTY OF WAYNE
Entity Type:Organization
Organization Name:COUNTY OF WAYNE
Other - Org Name:WAYNE COUNTY AREA AGENCY ON AGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HSA ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHYTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-253-4262
Mailing Address - Street 1:323 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1918
Mailing Address - Country:US
Mailing Address - Phone:570-253-4262
Mailing Address - Fax:570-253-9115
Practice Address - Street 1:323 10TH ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1918
Practice Address - Country:US
Practice Address - Phone:570-253-4262
Practice Address - Fax:570-253-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10017310820001Medicaid