Provider Demographics
NPI:1851412928
Name:COMMITTEE ON AGING RANDOLPH CO
Entity Type:Organization
Organization Name:COMMITTEE ON AGING RANDOLPH CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-636-4747
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-0727
Mailing Address - Country:US
Mailing Address - Phone:304-636-4747
Mailing Address - Fax:304-637-4991
Practice Address - Street 1:5TH STREET & RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-0727
Practice Address - Country:US
Practice Address - Phone:304-636-4747
Practice Address - Fax:304-637-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030580001Medicaid