Provider Demographics
NPI:1740298355
Name:PANHANDLE SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:PANHANDLE SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-242-9145
Mailing Address - Street 1:2227 CHAPLINE ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3842
Mailing Address - Country:US
Mailing Address - Phone:304-242-9145
Mailing Address - Fax:304-242-6965
Practice Address - Street 1:6441 FARMDALE RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1305
Practice Address - Country:US
Practice Address - Phone:304-453-4992
Practice Address - Fax:304-453-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X
WV068733310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0031018000Medicaid