Wakefield Cottage LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

207590 Issued in PA

Legal business name

WAKEFIELD COTTAGE LLC

Practice address

4 Nash Trail
Albrightsville, PA 18210-0314

Phone

(570) 722-8883

NPI assigned

May 21, 2009

Last updated

May 21, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Janice M Brown

Title

Ceo

Phone

(570) 722-8883

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242864000000",
    "number": "1023243987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 NASH TRAIL",
            "address_2": "PO BOX 314",
            "city": "ALBRIGHTSVILLE",
            "state": "PA",
            "postal_code": "18210",
            "telephone_number": "570-722-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 NASH TRAIL",
            "city": "ALBRIGHTSVILLE",
            "state": "PA",
            "postal_code": "182100314",
            "telephone_number": "570-722-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKEFIELD COTTAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-21",
        "last_updated": "2009-05-21",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JANICE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-722-8883"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "PA",
            "license": "207590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROMISE",
            "identifier": "100002859",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra Pileggi
• Daniel Plavin, MD
• Maria Stephanie Sanchez
• St. Luke's Physician Group, Inc
• Kayla Venneman

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Albrightsville, PA
• Providers in Albrightsville, PA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.