Healthcare Provider Details

I. General information

NPI: 1083749865
Provider Name (Legal Business Name): WIRT COUNTY COMMITTEE ON AGING AND FAMILY SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASHINGTON STREET
ELIZABETH WV
26143
US

IV. Provider business mailing address

PO BOX 370
ELIZABETH WV
26143-0370
US

V. Phone/Fax

Practice location:
  • Phone: 304-275-3158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE ROBERTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-275-3158