Provider Demographics
NPI:1265859482
Name:COUNCIL ON AGING, INC.
Entity Type:Organization
Organization Name:COUNCIL ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-294-8800
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:ITMANN
Mailing Address - State:WV
Mailing Address - Zip Code:24847-0130
Mailing Address - Country:US
Mailing Address - Phone:304-294-8800
Mailing Address - Fax:304-294-8803
Practice Address - Street 1:RT 10 OLD ITMANN GRADE SCHOOL
Practice Address - Street 2:
Practice Address - City:ITMANN
Practice Address - State:WV
Practice Address - Zip Code:24847
Practice Address - Country:US
Practice Address - Phone:304-294-8800
Practice Address - Fax:304-294-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWVM0004468979253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810022730Medicaid