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General NPI Number Information
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NPI Number | 1669872057
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Entity Type | Organization
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Legal Business Name | GREENBRIER COUNTY COMMITTEE ON AGING
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Dates
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Enumeration Date | 09/04/2014
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Last Update Date | 09/04/2014
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Provider Practice Location Address
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Address Line | 284 GREENBRIER STREET
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City | RUPERT
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State | WV
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Zip | 25984
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Country | US
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Telephone | 304-392-5138
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Fax | 304-392-5969
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Provider Business Mailing Address
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Address Line | 284 GREENBRIER STREET
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City | RUPERT
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State | WV
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Zip | 25984
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Country | US
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Telephone | 304-392-5138
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Fax | 304-392-5969
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN WYMAN
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Credential |
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Telephone | 304-392-5138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 10362952
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License Number State | WV
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