Organization
COUNCIL OF THE SOUTHERN MOUNTAINS, WV BRANCH, MCDOWELL CO CHAPTER, INC
Active
Organization
COUNCIL OF THE SOUTHERN MOUNTAINS, WV BRANCH, MCDOWELL CO CHAPTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDAL JOHNSON M.A. (EXECUTIVE DIRECTOR)
(304) 862-3144
Entity
Organization
Contact information
Practice address
69 MAIN STREET, CITY OF KEYSTONE BUILDING, KEYSTONE, WV 24868-0085
(304) 862-3144
(304) 862-3071
Mailing address
PO BOX 85, NORTHFORK, WV 24868-0085
(304) 862-3144
(304) 862-3071
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
3810005980
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810005980
—
WV
Enumeration date
10/31/2006
Last updated
08/22/2020
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