Healthcare Provider Details

I. General information

NPI: 1841288800
Provider Name (Legal Business Name): ESSENT HEALTHCARE - WAYNESBURG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 ELM DRIVE SUITE 2
WAYNESBURG PA
15370
US

IV. Provider business mailing address

265 ELM DRIVE SUITE 2
WAYNESBURG PA
15370
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-1900
  • Fax: 724-627-1998
Mailing address:
  • Phone: 724-627-1900
  • Fax: 724-627-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number713805
License Number StatePA

VIII. Authorized Official

Name: STEPHEN L. PAGE
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-844-9849