Organization
JOB SQUAD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL SICKLES (SES MANAGER)
(304) 848-0850
Entity
Organization
Contact information
Practice address
102 SECOND STREET, BRIDGEPORT, WV 26330
(304) 848-0850
(304) 848-0851
Mailing address
102 SECOND STREET, BRIDGEPORT, WV 26330
(304) 848-0850
(304) 848-0851
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
3502004000
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3502004000
—
WV
Enumeration date
02/19/2008
Last updated
02/19/2008
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