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NPI Code Detail

MEDICARE: RALEIGH COUNTY COMMISSION ON AGING, INC.

MEDICARE: RALEIGH COUNTY COMMISSION ON AGING, 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
13747A0650XAttendant Care ProviderWV
2103TC1900XCounseling PsychologistWV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376809186
Entity Type Code : Organization
Provider Name (Legal Business Name) : RALEIGH COUNTY COMMISSION ON AGING, INC.
Provider Business Mailing Address
First Line : 1614 S KANAWHA ST
Second Line :
City : BECKLEY
State : WV
Zip : 25801-6239
Country : US
Telephone Number : 304-255-1397
Fax Number : 304-252-9360
Provider Business Practice Location Address
First Line : 1614 S KANAWHA ST
Second Line :
City : BECKLEY
State : WV
Zip : 25801-6239
Country : US
Telephone Number : 304-255-1397
Fax Number : 304-252-9360
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JACK TANNER
Credential :
Telephone Number : 304-255-1397
Provider Enumeration Date : 04/05/2012
Last Update Date : 04/05/2012

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