Provider Demographics
NPI:1326266420
Name:THE WOOD COUNTY SENIOR CITIZENS ASSOCIATION
Entity Type:Organization
Organization Name:THE WOOD COUNTY SENIOR CITIZENS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-485-6748
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26102-1229
Mailing Address - Country:US
Mailing Address - Phone:304-485-6748
Mailing Address - Fax:304-485-8755
Practice Address - Street 1:914 MARKET ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4737
Practice Address - Country:US
Practice Address - Phone:304-485-6748
Practice Address - Fax:304-485-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030821002Medicaid
WV0030821000Medicaid