Healthcare Provider Details

I. General information

NPI: 1942347000
Provider Name (Legal Business Name): WAYNE COUNTY SENIOR CITIZENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FAIRLANE DRIVE
WAYNESBORO TN
38485-0775
US

IV. Provider business mailing address

PO BOX 775 202 FAIRLANE DRIVE
WAYNESBORO TN
38485-0775
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-3514
  • Fax: 931-722-7809
Mailing address:
  • Phone: 931-722-3514
  • Fax: 931-722-7809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MR. RALEIGH FAYE BREWER
Title or Position: DIRECTOR
Credential:
Phone: 931-722-3514