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NPI Code Detail

MEDICARE: PUTNAM COUNTY AGING PROGRAM, INC.

MEDICARE: PUTNAM COUNTY AGING PROGRAM, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1073912028
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUTNAM COUNTY AGING PROGRAM, INC.
Provider Business Mailing Address
First Line : 2558 WINFIELD RD
Second Line :
City : SAINT ALBANS
State : WV
Zip : 25177-7804
Country : US
Telephone Number : 304-755-2385
Fax Number :
Provider Business Practice Location Address
First Line : 2558 WINFIELD RD
Second Line :
City : SAINT ALBANS
State : WV
Zip : 25177-7804
Country : US
Telephone Number : 304-755-2385
Fax Number : 304-755-2389
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JENNIFER LYNN SUTHERLAND
Credential :
Telephone Number : 304-755-2385
Provider Enumeration Date : 08/15/2014
Last Update Date : 02/11/2022

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