Provider Demographics
NPI:1174667042
Name:COUNCIL OF SENIOR CITIZENS OF GILMER CO. INC.
Entity Type:Organization
Organization Name:COUNCIL OF SENIOR CITIZENS OF GILMER CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:OLDAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-462-5761
Mailing Address - Street 1:720 N LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-1319
Mailing Address - Country:US
Mailing Address - Phone:304-462-5761
Mailing Address - Fax:304-462-8239
Practice Address - Street 1:720 N LEWIS ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1319
Practice Address - Country:US
Practice Address - Phone:304-462-5761
Practice Address - Fax:304-462-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251V00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030583001Medicaid
WV0030583002Medicaid
WV0030583000Medicaid