MEDICARE: MONROE COUNTY COUNCIL 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
1	251E00000X	Home Health Agency	18730	WV

General Provider Information

NPI Number	:	1891901690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE COUNTY COUNCIL ON AGING INC

Provider Business Mailing Address
First Line	:	PO BOX 149
Second Line	:	OLD SCHOOL HOUSE RT 219
City	:	LINDSIDE
State	:	WV
Zip	:	24951
Country	:	US
Telephone Number	:	304-753-4384
Fax Number	:	304-753-9886

Provider Business Practice Location Address
First Line	:	RT 219 OLD SCHOOL HOUSE
Second Line	:
City	:	LINDSIDE
State	:	WV
Zip	:	24951
Country	:	US
Telephone Number	:	304-753-4384
Fax Number	:	304-753-9886

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. OTIS RICHARD PENCE
Credential	:
Telephone Number	:	304-753-4384

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	08/22/2020

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