Provider Demographics
NPI:1295091775
Name:PANHANDLE SUPPORT SERVICES, INC.
Entity type:Organization
Organization Name:PANHANDLE SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:WORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-242-9145
Mailing Address - Street 1:2177 NATIONAL RD
Mailing Address - Street 2:P.O. BOX 3037
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5238
Mailing Address - Country:US
Mailing Address - Phone:304-242-8404
Mailing Address - Fax:304-242-6965
Practice Address - Street 1:2177 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5238
Practice Address - Country:US
Practice Address - Phone:304-242-8404
Practice Address - Fax:304-242-6965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONAL IN-HOME SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-09
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0031018000Medicaid