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Organization

COUNCIL OF THE SOUTHERN MOUNTAINS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. RANDAL JOHNSON M.A. (EXECUTIVE DIRECTOR)
(304) 862-3144
Entity
Organization

Contact information

Practice address
69 MAIN ST., OLD KEYSTONE BANK 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
384
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3810007636
WV
Enumeration date
04/04/2007
Last updated
08/13/2008
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