Provider Demographics
NPI:1194264572
Name:FAMILY SERVICE - UPPER OHIO VALLEY
Entity type:Organization
Organization Name:FAMILY SERVICE - UPPER OHIO VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-233-2350
Mailing Address - Street 1:51 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2937
Mailing Address - Country:US
Mailing Address - Phone:304-233-2350
Mailing Address - Fax:
Practice Address - Street 1:51 11TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2937
Practice Address - Country:US
Practice Address - Phone:304-233-2350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10343857253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1326261082Medicaid
WV1972726644Medicaid
WV1578786158Medicaid