Provider Demographics
NPI:1831593813
Name:CALHOUN COUNTY COMMITTEE ON AGING
Entity type:Organization
Organization Name:CALHOUN COUNTY COMMITTEE ON AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:POLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-354-7017
Mailing Address - Street 1:105 MARKET STREET
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26147
Mailing Address - Country:US
Mailing Address - Phone:304-354-7017
Mailing Address - Fax:304-354-6859
Practice Address - Street 1:105 MARKET STREET
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26147
Practice Address - Country:US
Practice Address - Phone:304-354-7017
Practice Address - Fax:304-354-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10359463251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030566001Medicaid