Provider Demographics
NPI:1508205436
Name:COMMISSION ON AGING FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:COMMISSION ON AGING FAMILY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-257-1666
Mailing Address - Street 1:111 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-1713
Mailing Address - Country:US
Mailing Address - Phone:304-257-1666
Mailing Address - Fax:304-257-1945
Practice Address - Street 1:111 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1713
Practice Address - Country:US
Practice Address - Phone:304-257-1666
Practice Address - Fax:304-257-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10359713251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030591001Medicaid
WV3810009687Medicaid
WV0030591000Medicaid
WV3810022661Medicaid