Provider Demographics
NPI:1881818482
Name:UPSHUR COUNTY SENIOR CITIZENS OPPORTUNITY CENTER, INC.
Entity Type:Organization
Organization Name:UPSHUR COUNTY SENIOR CITIZENS OPPORTUNITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-472-0528
Mailing Address - Street 1:28 N KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2714
Mailing Address - Country:US
Mailing Address - Phone:304-472-0528
Mailing Address - Fax:304-472-6424
Practice Address - Street 1:28 N KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2714
Practice Address - Country:US
Practice Address - Phone:304-472-0528
Practice Address - Fax:304-472-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030789000Medicaid
WV0030789001Medicaid