Individual
CHARITY REGISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
804 INDUSTRIAL PARK RD, MAXWELTON, WV 24957-8066
(304) 497-0500
(304) 497-2707
Mailing address
PO BOX 129, MAXWELTON, WV 24957-0129
(304) 497-0500
(304) 497-2707
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/19/2020
Last updated
03/19/2020
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