Provider Demographics
NPI:1821270026
Name:SENIOR MONONGALIANS, INC.
Entity Type:Organization
Organization Name:SENIOR MONONGALIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-296-9812
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0653
Mailing Address - Country:US
Mailing Address - Phone:304-296-9812
Mailing Address - Fax:304-296-3917
Practice Address - Street 1:5000 GREENBAG RD
Practice Address - Street 2:SUITE A5
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7163
Practice Address - Country:US
Practice Address - Phone:304-296-9812
Practice Address - Fax:304-296-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009971Medicaid