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General NPI Number Information
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NPI Number | 1023243987
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Entity Type | Organization
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Legal Business Name | WAKEFIELD COTTAGE LLC
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Dates
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Enumeration Date | 05/21/2009
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 4 NASH TRAIL
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City | ALBRIGHTSVILLE
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State | PA
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Zip | 18210-0314
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Country | US
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Telephone | 570-722-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 4 NASH TRAIL PO BOX 314
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City | ALBRIGHTSVILLE
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State | PA
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Zip | 18210
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Country | US
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Telephone | 570-722-8883
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JANICE M BROWN
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Credential |
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Telephone | 570-722-8883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 207590
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License Number State | PA
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