Provider Demographics
NPI:1437262078
Name:MCDOWELL COUNTY COMMISSION ON AGING
Entity Type:Organization
Organization Name:MCDOWELL COUNTY COMMISSION ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-436-6588
Mailing Address - Street 1:725 STEWART ST
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2125
Mailing Address - Country:US
Mailing Address - Phone:304-436-6588
Mailing Address - Fax:304-436-3901
Practice Address - Street 1:725 STEWART ST
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2125
Practice Address - Country:US
Practice Address - Phone:304-436-6588
Practice Address - Fax:304-436-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030657000Medicaid
WV0030657001Medicaid
WV0030657002Medicaid