Organization
GREENBRIER COUNTY COMMITTEE ON AGING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WYMAN (EXECUTIVE DIRECTOR)
(304) 392-5138
Entity
Organization
Contact information
Practice address
284 GREENBRIER STREET, RUPERT, WV 25984
(304) 392-5138
(304) 392-5969
Mailing address
284 GREENBRIER STREET, RUPERT, WV 25984
(304) 392-5138
(304) 392-5969
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
10362952
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0030600000
—
WV
05
—
0030600001
—
WV
Enumeration date
09/04/2014
Last updated
09/04/2014
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