Healthcare Provider Details

I. General information

NPI: 1831593813
Provider Name (Legal Business Name): CALHOUN COUNTY COMMITTEE ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MARKET STREET
GRANTSVILLE WV
26147
US

IV. Provider business mailing address

105 MARKET STREET
GRANTSVILLE WV
26147
US

V. Phone/Fax

Practice location:
  • Phone: 304-354-7017
  • Fax: 304-354-6859
Mailing address:
  • Phone: 304-354-7017
  • Fax: 304-354-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number10359463
License Number StateWV

VIII. Authorized Official

Name: RICK POLING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-354-7017