Provider Demographics
NPI:1508265562
Name:TUCKER COUNTY SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:TUCKER COUNTY SENIOR CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:NESTOR
Authorized Official - Last Name:TUESING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-478-2423
Mailing Address - Street 1:217 SENIOR LN
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-1321
Mailing Address - Country:US
Mailing Address - Phone:304-478-2423
Mailing Address - Fax:304-478-4828
Practice Address - Street 1:217 SENIOR LN
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-1321
Practice Address - Country:US
Practice Address - Phone:304-478-2423
Practice Address - Fax:304-478-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1093837999Medicaid