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Certified Provider Details:
| PROVIDER NUMBER: | 490080 |
| AGENCY NAME: | Central WV Aging Services, Inc. |
| CONTACT NAME: | Betty Talbott |
| ADDRESS: | PO Box 186 |
| CITY: | Buckhannon |
| STATE: | WV |
| ZIP: | 26201 |
| PHONE: | |
| WEB SITE: | www.msys.net/cwvasi |
| EMAIL ADDRESS: | epost@wvdsl.net |
| BSW/MSW NAME: | Deborah Casebolt |
| DUE TO RECERTIFY DATE: | 7/1/2011 |
| COMMENTS: |