Provider Demographics
NPI:1932513736
Name:BERKELEY CO COMM ON AGING
Entity Type:Organization
Organization Name:BERKELEY CO COMM ON AGING
Other - Org Name:BERKELEY SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTZAPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-8873
Mailing Address - Street 1:217 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-4419
Mailing Address - Country:US
Mailing Address - Phone:304-263-8873
Mailing Address - Fax:304-596-2254
Practice Address - Street 1:217 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-4419
Practice Address - Country:US
Practice Address - Phone:304-263-8873
Practice Address - Fax:304-596-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030536001Medicaid