Provider Demographics
NPI:1568796027
Name:COMMUNITY ACTION OF SOUTHEASTERN WEST VIRGINIA
Entity Type:Organization
Organization Name:COMMUNITY ACTION OF SOUTHEASTERN WEST VIRGINIA
Other - Org Name:CASE WV COMMISSION ON AGING
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ORAETTA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-327-3501
Mailing Address - Street 1:307 FEDERAL ST
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3063
Mailing Address - Country:US
Mailing Address - Phone:304-327-3506
Mailing Address - Fax:304-327-8822
Practice Address - Street 1:355 BLUEFIELD AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-2883
Practice Address - Country:US
Practice Address - Phone:304-327-3506
Practice Address - Fax:304-327-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care