Provider Demographics
NPI:1083989701
Name:COMMITTEE FOR HANCOCK COUNTY SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:COMMITTEE FOR HANCOCK COUNTY SENIOR CITIZENS, INC.
Other - Org Name:HANCOCK COUNTY SENIOR WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:E
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:KNABENSHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-564-3801
Mailing Address - Street 1:647 GAS VALLEY ROAD
Mailing Address - Street 2:PO BOX 1284
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:WV
Mailing Address - Zip Code:26047-1284
Mailing Address - Country:US
Mailing Address - Phone:304-564-3801
Mailing Address - Fax:304-387-2693
Practice Address - Street 1:647 GAS VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:WV
Practice Address - Zip Code:26047-1284
Practice Address - Country:US
Practice Address - Phone:304-564-3801
Practice Address - Fax:304-387-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4703006000Medicaid
WV4703006002Medicaid
WV4703006001Medicaid