Provider Demographics
NPI:1811109770
Name:APPALACHIAN AGENCY FOR SENIOR CITIZENS
Entity type:Organization
Organization Name:APPALACHIAN AGENCY FOR SENIOR CITIZENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NETTIE
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:SAYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-964-4915
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0765
Mailing Address - Country:US
Mailing Address - Phone:276-964-4915
Mailing Address - Fax:276-963-0130
Practice Address - Street 1:216 COLLEGE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609
Practice Address - Country:US
Practice Address - Phone:276-964-4915
Practice Address - Fax:276-963-0130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPALACHIAN AGENCY FOR SENIOR CITIZENS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-04
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAWLO-07-108ADC 958134251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization