MEDICARE: MONROE COUNTY COUNCIL 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	251V00000X	Voluntary or Charitable Agency	1025-2097	WV

General Provider Information

NPI Number	:	1952721987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE COUNTY COUNCIL ON AGING

Provider Business Mailing Address
First Line	:	PO BOX 149
Second Line	:
City	:	LINDSIDE
State	:	WV
Zip	:	24951-0149
Country	:	US
Telephone Number	:	304-753-4384
Fax Number	:

Provider Business Practice Location Address
First Line	:	8395 SENECA TRAIL SOUTH
Second Line	:
City	:	LINDSIDE
State	:	WV
Zip	:	24951-0149
Country	:	US
Telephone Number	:	304-753-4384
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATION OFFICER
Name	:	MR. BRUCE L. POWER SR.
Credential	:
Telephone Number	:	304-753-4384

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	04/17/2014

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