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General NPI Number Information
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NPI Number | 1831593813
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Entity Type | Organization
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Legal Business Name | CALHOUN COUNTY COMMITTEE ON AGING
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Dates
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Enumeration Date | 10/20/2014
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 105 MARKET STREET
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City | GRANTSVILLE
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State | WV
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Zip | 26147
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Country | US
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Telephone | 304-354-7017
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Fax | 304-354-6859
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Provider Business Mailing Address
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Address Line | 105 MARKET STREET
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City | GRANTSVILLE
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State | WV
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Zip | 26147
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Country | US
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Telephone | 304-354-7017
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Fax | 304-354-6859
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RICK POLING
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Credential |
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Telephone | 304-354-7017
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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 | 10359463
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License Number State | WV
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