Provider Demographics
NPI:1013100163
Name:SENIOR LIFE SERVICES OF MORGAN COUNTY, INC.
Entity Type:Organization
Organization Name:SENIOR LIFE SERVICES OF MORGAN COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-258-3096
Mailing Address - Street 1:187 S GREEN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-1745
Mailing Address - Country:US
Mailing Address - Phone:304-258-3096
Mailing Address - Fax:304-258-3190
Practice Address - Street 1:187 S GREEN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-1745
Practice Address - Country:US
Practice Address - Phone:304-258-3096
Practice Address - Fax:304-258-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030693002Medicaid
WV0030693000Medicaid