Provider Demographics
NPI:1619370137
Name:LEWIS COUNTY SENIOR CITIZENS CENTER
Entity type:Organization
Organization Name:LEWIS COUNTY SENIOR CITIZENS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-269-5738
Mailing Address - Street 1:171 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-1665
Mailing Address - Country:US
Mailing Address - Phone:304-269-5738
Mailing Address - Fax:304-269-7329
Practice Address - Street 1:171 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-1665
Practice Address - Country:US
Practice Address - Phone:304-269-5738
Practice Address - Fax:304-269-7329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWIS COUNTY SENIOR CITIZENS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-29
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030634003Medicaid