Healthcare Provider Details

I. General information

NPI: 1063015113
Provider Name (Legal Business Name): WASHINGTON COUNTY COMMISSION ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E FRANKLIN ST
HAGERSTOWN MD
21740-5056
US

IV. Provider business mailing address

535 E FRANKLIN ST
HAGERSTOWN MD
21740-5056
US

V. Phone/Fax

Practice location:
  • Phone: 301-790-0275
  • Fax: 301-739-4957
Mailing address:
  • Phone: 301-790-0275
  • Fax: 301-739-4957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. AMY OLACK
Title or Position: CEO
Credential: NHA
Phone: 301-790-0275