# SPINA BIFIDA ASSOCIATION OF WESTERN PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518470319
- **Authorized official:** SALLY ANN BAYUK (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (724) 934-9600

## Contact information

- **Practice address:** 3000 STONEWOOD DR STE 100, WEXFORD, PA 15090-8317
- **Practice address phone:** (724) 934-9600
- **Practice address fax:** (724) 934-9610
- **Mailing address:** 3000 STONEWOOD DR STE 100, WEXFORD, PA 15090-8317
- **Mailing address phone:** (724) 934-9600
- **Mailing address fax:** (724) 934-9610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | 10253601 | PA | Yes |

## Other

- **Enumeration date:** 11/15/2017
- **Last updated:** 11/15/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001941320 | PROMISE ID | PA |