Provider Demographics
NPI:1871252700
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:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-333-4155
Mailing Address - Street 1:51 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:NY
Mailing Address - Zip Code:14489-1122
Mailing Address - Country:US
Mailing Address - Phone:315-333-4155
Mailing Address - Fax:
Practice Address - Street 1:51 BROAD ST
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489-1122
Practice Address - Country:US
Practice Address - Phone:315-333-4155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty