MEDICARE: SENIOR LIFE SERVICES OF MORGAN COUNTY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134599616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR LIFE SERVICES OF MORGAN COUNTY, INC

Provider Business Mailing Address
First Line	:	106 SAND MINE RD
Second Line	:	SUITE #1
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-7457
Country	:	US
Telephone Number	:	304-258-3096
Fax Number	:	304-258-3190

Provider Business Practice Location Address
First Line	:	106 SAND MINE RD
Second Line	:	SUITE #1
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-7457
Country	:	US
Telephone Number	:	304-258-3096
Fax Number	:	304-258-3190

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOEL R TUTTLE
Credential	:
Telephone Number	:	304-258-3096

Provider Enumeration Date	:	09/28/2015
Last Update Date	:	09/28/2015

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