Provider Demographics
NPI:1124238803
Name:PUTNAM COUNTY AGING, INC.
Entity type:Organization
Organization Name:PUTNAM COUNTY AGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-755-2385
Mailing Address - Street 1:694 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-1554
Mailing Address - Country:US
Mailing Address - Phone:304-755-2385
Mailing Address - Fax:304-755-8247
Practice Address - Street 1:694 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-1554
Practice Address - Country:US
Practice Address - Phone:304-755-2385
Practice Address - Fax:304-755-8247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030736000Medicaid
WV0030736001Medicaid
WV0030736002Medicaid
WV3810001928Medicaid