Provider Demographics
NPI:1134599616
Name:SENIOR LIFE SERVICES OF MORGAN COUNTY, INC
Entity type:Organization
Organization Name:SENIOR LIFE SERVICES OF MORGAN COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-258-3096
Mailing Address - Street 1:106 SAND MINE RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-7457
Mailing Address - Country:US
Mailing Address - Phone:304-258-3096
Mailing Address - Fax:304-258-3190
Practice Address - Street 1:106 SAND MINE RD
Practice Address - Street 2:SUITE #1
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-7457
Practice Address - Country:US
Practice Address - Phone:304-258-3096
Practice Address - Fax:304-258-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030693002Medicaid