Provider Demographics
NPI:1780083493
Name:HARDY COUNTY COMMITTEE ON AGING
Entity type:Organization
Organization Name:HARDY COUNTY COMMITTEE ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-530-2761
Mailing Address - Street 1:409 SPRING AVE
Mailing Address - Street 2:P. O. BOX 632
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-1036
Mailing Address - Country:US
Mailing Address - Phone:304-530-2256
Mailing Address - Fax:
Practice Address - Street 1:409 SPRING AVE
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-1036
Practice Address - Country:US
Practice Address - Phone:304-530-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030613001Medicaid