Provider Demographics
NPI:1578786158
Name:FAMILY SERVICE-UPPER OHIO VALLEY
Entity Type:Organization
Organization Name:FAMILY SERVICE-UPPER OHIO VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT GERIATRIC PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEINDECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-233-2350
Mailing Address - Street 1:51 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2937
Mailing Address - Country:US
Mailing Address - Phone:304-233-2350
Mailing Address - Fax:304-233-7237
Practice Address - Street 1:51 11TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2937
Practice Address - Country:US
Practice Address - Phone:304-233-2350
Practice Address - Fax:304-233-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023426005Medicaid