Healthcare Provider Details

I. General information

NPI: 1932513736
Provider Name (Legal Business Name): BERKELEY CO COMM ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N HIGH ST
MARTINSBURG WV
25404-4419
US

IV. Provider business mailing address

217 N HIGH ST
MARTINSBURG WV
25404-4419
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-8873
  • Fax: 304-596-2254
Mailing address:
  • Phone: 304-263-8873
  • Fax: 304-596-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateWV

VIII. Authorized Official

Name: LINDA HOLTZAPPLE
Title or Position: DIRECTOR
Credential:
Phone: 304-263-8873