Provider Demographics
NPI:1467679209
Name:HARDY COUNTY COMMITTEE ON AGING
Entity Type:Organization
Organization Name:HARDY COUNTY COMMITTEE ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-530-2256
Mailing Address - Street 1:409 SPRING AVE
Mailing Address - Street 2:P O BOX 632
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1036
Mailing Address - Country:US
Mailing Address - Phone:304-530-2256
Mailing Address - Fax:304-530-6989
Practice Address - Street 1:409 SPRING AVE
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1036
Practice Address - Country:US
Practice Address - Phone:304-530-2256
Practice Address - Fax:304-530-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV376J00000X376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030613001Medicaid
WV0030613000Medicaid