Healthcare Provider Details

I. General information

NPI: 1588966428
Provider Name (Legal Business Name): SILVER AGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 11/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N HIGH ST
MARTINSBURG WV
25404-4791
US

IV. Provider business mailing address

1000 N HIGH ST
MARTINSBURG WV
25404-4791
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-1717
  • Fax: 304-267-3490
Mailing address:
  • Phone: 304-267-1717
  • Fax: 304-267-3490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateWV

VIII. Authorized Official

Name: ELAINE C MAUCK
Title or Position: ADMINISTRATOR
Credential:
Phone: 304-671-5994