Provider Demographics
NPI:1275388670
Name:PANHANDLE SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:PANHANDLE SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONA
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-242-9145
Mailing Address - Street 1:2227 CHAPLINE ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3842
Mailing Address - Country:US
Mailing Address - Phone:304-617-1378
Mailing Address - Fax:
Practice Address - Street 1:2227 CHAPLINE ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3842
Practice Address - Country:US
Practice Address - Phone:304-617-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health