Provider Demographics
NPI:1891977575
Name:COUNCIL OF SENIOR TYLER COUNTIANS, INC.
Entity Type:Organization
Organization Name:COUNCIL OF SENIOR TYLER COUNTIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-758-4919
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBOURNE
Mailing Address - State:WV
Mailing Address - Zip Code:26149-0068
Mailing Address - Country:US
Mailing Address - Phone:304-758-4919
Mailing Address - Fax:304-758-4860
Practice Address - Street 1:504 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBOURNE
Practice Address - State:WV
Practice Address - Zip Code:26149
Practice Address - Country:US
Practice Address - Phone:304-758-4919
Practice Address - Fax:304-758-4860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030589000Medicaid