Provider Demographics
NPI:1255476511
Name:KANAWHA VALLEY SENIOR SERVICES
Entity Type:Organization
Organization Name:KANAWHA VALLEY SENIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:304-348-0707
Mailing Address - Street 1:2428 KANAWHA BLVD E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2323
Mailing Address - Country:US
Mailing Address - Phone:304-348-0707
Mailing Address - Fax:304-348-6432
Practice Address - Street 1:2428 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2323
Practice Address - Country:US
Practice Address - Phone:304-348-0707
Practice Address - Fax:304-348-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023790003Medicaid