Provider Demographics
NPI:1588966428
Name:SILVER AGE SERVICES
Entity type:Organization
Organization Name:SILVER AGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-671-5994
Mailing Address - Street 1:1000 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-4791
Mailing Address - Country:US
Mailing Address - Phone:304-267-1717
Mailing Address - Fax:304-267-3490
Practice Address - Street 1:1000 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-4791
Practice Address - Country:US
Practice Address - Phone:304-267-1717
Practice Address - Fax:304-267-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility