Provider Demographics
NPI:1144644915
Name:WORMACK INC.
Entity type:Organization
Organization Name:WORMACK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:WORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:724-570-3556
Mailing Address - Street 1:210 SNYDER ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3448
Mailing Address - Country:US
Mailing Address - Phone:724-626-2171
Mailing Address - Fax:
Practice Address - Street 1:201 E FAIRVIEW AVE
Practice Address - Street 2:SUITE 206, 2ND FLOOR
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3703
Practice Address - Country:US
Practice Address - Phone:724-570-3556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WORMACK INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-13
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable