Organization
SPINA BIFIDA ASSOCIATION OF WESTERN PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY ANN BAYUK (EXECUTIVE DIRECTOR)
(724) 934-9600
Entity
Organization
Contact information
Practice address
3000 STONEWOOD DR STE 100, WEXFORD, PA 15090-8317
(724) 934-9600
(724) 934-9610
Mailing address
3000 STONEWOOD DR STE 100, WEXFORD, PA 15090-8317
(724) 934-9600
(724) 934-9610
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
10253601
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001941320
PROMISE ID
PA
Enumeration date
11/15/2017
Last updated
11/15/2017
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