MEDICARE: COUNTY OF WAYNE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073651071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF WAYNE

Provider Business Mailing Address
First Line	:	648 PARK ST
Second Line	:	SUITE A
City	:	HONESDALE
State	:	PA
Zip	:	18431-1446
Country	:	US
Telephone Number	:	570-253-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	648 PARK ST
Second Line	:	SUITE A
City	:	HONESDALE
State	:	PA
Zip	:	18431-1446
Country	:	US
Telephone Number	:	570-253-9200
Fax Number	:

Authorized Official
Title or Position	:	MHMR ADMINISTRATOR
Name	:	MARGARET ENNIS
Credential	:
Telephone Number	:	570-253-9200

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	09/22/2015

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Directions to “COUNTY OF WAYNE ” Practice Location

Language	Start Address	Practice Location

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