MEDICARE: WVSU METRO AREA AGENCY ON AGING

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1184961443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WVSU METRO AREA AGENCY ON AGING

Provider Business Mailing Address
First Line	:	1 DUNBAR PLZ
Second Line	:	SUITE 102
City	:	DUNBAR
State	:	WV
Zip	:	25064-3038
Country	:	US
Telephone Number	:	304-720-6858
Fax Number	:	304-720-6864

Provider Business Practice Location Address
First Line	:	1 DUNBAR PLZ
Second Line	:	SUITE 102
City	:	DUNBAR
State	:	WV
Zip	:	25064-3038
Country	:	US
Telephone Number	:	304-720-6858
Fax Number	:	304-720-6864

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. BRENDA K LANDERS
Credential	:
Telephone Number	:	304-720-6858

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/07/2013

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