Provider Demographics
NPI:1841288800
Name:ESSENT HEALTHCARE - WAYNESBURG LLC
Entity type:Organization
Organization Name:ESSENT HEALTHCARE - WAYNESBURG LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-844-9849
Mailing Address - Street 1:265 ELM DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370
Mailing Address - Country:US
Mailing Address - Phone:724-627-1900
Mailing Address - Fax:724-627-1998
Practice Address - Street 1:265 ELM DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370
Practice Address - Country:US
Practice Address - Phone:724-627-1900
Practice Address - Fax:724-627-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA713805251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395772OtherFEDERAL BLACK LUNG
PA1007722070007Medicaid
PA1500357OtherGATEWAY
PA53513OtherADVANTRA/HEALTH ASSURANCE
PA0756OtherBLUE CROSS
PA75735OtherTHREE RIVERS/MED PLUS
PA0812609OtherUMWA
PA75735OtherTHREE RIVERS/MED PLUS