Provider Demographics
NPI:1972810935
Name:MARION COUNTY SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:MARION COUNTY SENIOR CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-366-8779
Mailing Address - Street 1:105 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2147
Mailing Address - Country:US
Mailing Address - Phone:304-366-8779
Mailing Address - Fax:304-366-3186
Practice Address - Street 1:105 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2147
Practice Address - Country:US
Practice Address - Phone:304-366-8779
Practice Address - Fax:304-366-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4703017000Medicaid