Provider Demographics
NPI:1295952513
Name:JACKSON COUNTY COMMISSION ON AGING, INC
Entity type:Organization
Organization Name:JACKSON COUNTY COMMISSION ON AGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-372-2406
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:121 SOUTH COURT STREET
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-0617
Mailing Address - Country:US
Mailing Address - Phone:304-372-2406
Mailing Address - Fax:304-372-9243
Practice Address - Street 1:121 COURT ST S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1408
Practice Address - Country:US
Practice Address - Phone:304-372-2406
Practice Address - Fax:304-372-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030617001Medicaid