Organization
P.R.I.D.E. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA YORK (BILLING CLERK)
(304) 752-6868
Entity
Organization
Contact information
Practice address
699 STRATTON ST, LOGAN, WV 25601-4020
(304) 752-6868
(304) 752-1047
Mailing address
PO BOX 1346, LOGAN, WV 25601-1346
(304) 752-6868
(304) 752-1047
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009467
—
WV
Enumeration date
08/16/2007
Last updated
08/16/2007
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