Healthcare Provider Details

I. General information

NPI: 1124238803
Provider Name (Legal Business Name): PUTNAM COUNTY AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 WINFIELD RD
SAINT ALBANS WV
25177-1554
US

IV. Provider business mailing address

694 WINFIELD RD
SAINT ALBANS WV
25177-1554
US

V. Phone/Fax

Practice location:
  • Phone: 304-755-2385
  • Fax: 304-755-8247
Mailing address:
  • Phone: 304-755-2385
  • Fax: 304-755-8247

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: MS. DEBRA DOSS
Title or Position: FISCAL OFFICER
Credential:
Phone: 304-755-2385