Organization
CLAY CO. DEV
Active
Other names
Tender Heart
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY M. MCKINNEY (OFFICE MANAGER/BILLING CLERK)
(304) 872-9115
Entity
Organization
Contact information
Practice address
812 NORTHSIDE DR, SUMMERSVILLE, WV 26651-2028
(304) 872-9115
(304) 872-9227
Mailing address
812 NORTHSIDE DR, SUMMERSVILLE, WV 26651-2028
(304) 872-9115
(304) 872-9227
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
21874703
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33810011359
—
WV
Enumeration date
03/24/2008
Last updated
07/03/2008
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