MEDICARE: WAYNESBURG ADULT DAY CARE, INC.

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	261QA0600X	Adult Day Care Clinic/Center	084950	PA

General Provider Information

NPI Number	:	1710268545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNESBURG ADULT DAY CARE, INC.

Provider Business Mailing Address
First Line	:	209 SIGMA DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-2826
Country	:	US
Telephone Number	:	412-963-9150
Fax Number	:	412-963-6676

Provider Business Practice Location Address
First Line	:	55 SUGAR RUN RD
Second Line	:
City	:	WAYNESBURG
State	:	PA
Zip	:	15370-9644
Country	:	US
Telephone Number	:	724-852-2273
Fax Number	:

Authorized Official
Title or Position	:	DIR. OF REIMBURSEMENT
Name	:	MR. HERBERT H HENNELL
Credential	:
Telephone Number	:	412-963-9150

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/26/2016

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