Provider Demographics
NPI:1740609973
Name:BRAXTON COUNTY SENIOR CITIZENS CENTER, INC.
Entity Type:Organization
Organization Name:BRAXTON COUNTY SENIOR CITIZENS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-765-4090
Mailing Address - Street 1:23 SENIOR CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9581
Mailing Address - Country:US
Mailing Address - Phone:304-765-4090
Mailing Address - Fax:304-765-4095
Practice Address - Street 1:23 SENIOR CENTER DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9581
Practice Address - Country:US
Practice Address - Phone:304-765-4090
Practice Address - Fax:304-765-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103612813747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030549002Medicaid