Provider Demographics
NPI:1891901690
Name:MONROE COUNTY COUNCIL ON AGING INC
Entity Type:Organization
Organization Name:MONROE COUNTY COUNCIL ON AGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-753-4384
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:OLD SCHOOL HOUSE RT 219
Mailing Address - City:LINDSIDE
Mailing Address - State:WV
Mailing Address - Zip Code:24951
Mailing Address - Country:US
Mailing Address - Phone:304-753-4384
Mailing Address - Fax:304-753-9886
Practice Address - Street 1:RT 219 OLD SCHOOL HOUSE
Practice Address - Street 2:
Practice Address - City:LINDSIDE
Practice Address - State:WV
Practice Address - Zip Code:24951
Practice Address - Country:US
Practice Address - Phone:304-753-4384
Practice Address - Fax:304-753-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18730251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health