Provider Demographics
NPI:1285779322
Name:BERKELEY COUNTY COMMITTEE ON AGING, INC.
Entity type:Organization
Organization Name:BERKELEY COUNTY COMMITTEE ON AGING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORNDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-8873
Mailing Address - Street 1:217 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4419
Mailing Address - Country:US
Mailing Address - Phone:304-263-8873
Mailing Address - Fax:304-263-6598
Practice Address - Street 1:217 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4419
Practice Address - Country:US
Practice Address - Phone:304-263-8873
Practice Address - Fax:304-263-6598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV036969171W00000X
251E00000X, 251J00000X, 251X00000X, 253Z00000X, 261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030536001Medicaid
WV0030536002Medicaid
WV0030536000Medicaid