Provider Demographics
NPI:1013140870
Name:WAYNE COUNTY OFFICE OF MH/MR
Entity Type:Organization
Organization Name:WAYNE COUNTY OFFICE OF MH/MR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, MENTAL HEALTH/MENTAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:M
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:570-253-9200
Mailing Address - Street 1:648 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1446
Mailing Address - Country:US
Mailing Address - Phone:570-253-9200
Mailing Address - Fax:570-647-0268
Practice Address - Street 1:1100 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1943
Practice Address - Country:US
Practice Address - Phone:570-253-9200
Practice Address - Fax:570-647-0268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF WAYNE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001731082Medicaid