Provider Demographics
NPI:1669671236
Name:WATWO
Entity type:Organization
Organization Name:WATWO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALTOMARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-339-4049
Mailing Address - Street 1:121 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-2140
Mailing Address - Country:US
Mailing Address - Phone:570-339-4049
Mailing Address - Fax:
Practice Address - Street 1:121 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2140
Practice Address - Country:US
Practice Address - Phone:570-339-4049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001785490002Medicaid