Provider Demographics
NPI:1952547770
Name:WAYNE COUNTY ASSISTED LIVING FACILITY
Entity Type:Organization
Organization Name:WAYNE COUNTY ASSISTED LIVING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-722-2000
Mailing Address - Street 1:210 FAIRLANE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-2419
Mailing Address - Country:US
Mailing Address - Phone:931-722-2000
Mailing Address - Fax:
Practice Address - Street 1:210 FAIRLANE DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2419
Practice Address - Country:US
Practice Address - Phone:931-722-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACL0000000227310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility