Provider Demographics
NPI:1962460642
Name:WAYNE HEALTH SERVICES & SUPPLIES, INC.
Entity Type:Organization
Organization Name:WAYNE HEALTH SERVICES & SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-363-6430
Mailing Address - Street 1:2571 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1700
Mailing Address - Country:US
Mailing Address - Phone:330-345-7730
Mailing Address - Fax:330-345-6217
Practice Address - Street 1:2571 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1700
Practice Address - Country:US
Practice Address - Phone:330-345-7730
Practice Address - Fax:330-345-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85 026097332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0644842Medicaid
OH0644842Medicaid
OH0644842Medicaid