Provider Demographics
NPI:1972251395
Name:WADDINGTON REHAB CENTER LLC
Entity Type:Organization
Organization Name:WADDINGTON REHAB CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-483-4282
Mailing Address - Street 1:100 STOOPS DR STE 240
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-3553
Mailing Address - Country:US
Mailing Address - Phone:724-483-4282
Mailing Address - Fax:724-453-4078
Practice Address - Street 1:701 PENN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1362
Practice Address - Country:US
Practice Address - Phone:724-483-4282
Practice Address - Fax:724-483-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103789549002Medicaid