Provider Demographics
NPI:1972726099
Name:MERCER COUNTY COMMISSION ON AGING, INC.
Entity Type:Organization
Organization Name:MERCER COUNTY COMMISSION ON AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-425-7111
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1507
Mailing Address - Country:US
Mailing Address - Phone:304-425-7111
Mailing Address - Fax:304-487-8801
Practice Address - Street 1:600 TRENT ST.
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-1507
Practice Address - Country:US
Practice Address - Phone:304-425-7111
Practice Address - Fax:304-487-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251E00000X251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030667000Medicaid
WV0030667001Medicaid