Provider Demographics
NPI:1760664635
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:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-478-2423
Mailing Address - Street 1:206 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:WV
Mailing Address - Zip Code:26287-1041
Mailing Address - Country:US
Mailing Address - Phone:304-478-2423
Mailing Address - Fax:304-478-4828
Practice Address - Street 1:206 3RD ST
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:WV
Practice Address - Zip Code:26287-1041
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:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030787001Medicaid
WV0030787000Medicaid
WV0030787002Medicaid