Healthcare Provider Details

I. General information

NPI: 1376818526
Provider Name (Legal Business Name): MCDOWELL COUNTY COMMISSION ON AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 STEWART ST
WELCH WV
24801-2125
US

IV. Provider business mailing address

725 STEWART ST
WELCH WV
24801-2125
US

V. Phone/Fax

Practice location:
  • Phone: 304-436-6588
  • Fax: 304-436-2006
Mailing address:
  • Phone: 304-436-6588
  • Fax: 304-436-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberFE271147
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA E SANDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-436-6588