MEDICARE: WAYNE COUNTY REGIONAL EDUCATIONAL SERVICE AGENCY

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	251300000X	Local Education Agency (LEA)

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	:	1578582045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE COUNTY REGIONAL EDUCATIONAL SERVICE AGENCY

Provider Business Mailing Address
First Line	:	33500 VAN BORN ROAD
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184
Country	:	US
Telephone Number	:	734-334-1820
Fax Number	:	734-334-1824

Provider Business Practice Location Address
First Line	:	33500 VAN BORN RD
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-2474
Country	:	US
Telephone Number	:	734-334-1820
Fax Number	:	734-334-1824

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR, MEDICAID REIMB
Name	:	MS. KATHLEEN CUMMINS MERRY
Credential	:
Telephone Number	:	734-334-1820

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	08/22/2020

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