Healthcare Provider Details

I. General information

NPI: 1235557018
Provider Name (Legal Business Name): COMMISSION ON AGING FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 VIRGINIA AVE
PETERSBURG WV
26847-1713
US

IV. Provider business mailing address

111 VIRGINIA AVE
PETERSBURG WV
26847-1713
US

V. Phone/Fax

Practice location:
  • Phone: 304-257-1666
  • Fax: 304-257-9145
Mailing address:
  • Phone: 304-257-1666
  • Fax: 304-257-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10359713
License Number StateWV

VIII. Authorized Official

Name: DARLENE E EVANS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-257-1666