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Organization
ST OF WV DIV OF REHABILITATION SERVICES
Active
Organization
ST OF WV DIV OF REHABILITATION SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAINE WILDER (ASSISTANT DIRECTOR, CENTER ADMINIST)
(304) 766-4767
Entity
Organization
Contact information
Practice address
BARRON DRIVE, INSTITUTE, WV 25112-1004
(304) 766-4848
(304) 766-4937
Mailing address
PO BOX 1004, INSTITUTE, WV 25112-1004
(304) 766-4848
(304) 766-4937
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
NA GOV'T OWNED
WV
Other
Enumeration date
11/30/2005
Last updated
08/22/2020
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