Provider Demographics
NPI:1790193977
Name:SUMMERS COUNTY COUNCIL ON AGING, INC
Entity Type:Organization
Organization Name:SUMMERS COUNTY COUNCIL ON AGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINVILLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-466-4019
Mailing Address - Street 1:120 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2402
Mailing Address - Country:US
Mailing Address - Phone:304-466-4019
Mailing Address - Fax:304-466-1890
Practice Address - Street 1:120 2ND AVE
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2402
Practice Address - Country:US
Practice Address - Phone:304-466-4019
Practice Address - Fax:304-466-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVUD000121045001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030778001Medicaid