Organization
GREEN ACRES REGIONAL CTR INC
Active
Organization
GREEN ACRES REGIONAL CTR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EMMA SUE SMITH (EXECUTIVE DIRECTOR)
(304) 762-2520
Entity
Organization
Contact information
Practice address
7830 OHIO RIVER ROAD, LESAGE, WV 25537
(304) 762-2522
(304) 762-2862
Mailing address
PO BOX 240, 7830 OHIO RIVER ROAD, LESAGE, WV 25537
(304) 762-2522
(304) 762-2862
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
0005317000
—
261QR0400X
Rehabilitation Clinic/Center
0005317002
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005317000
—
WV
01
—
0005317002
REHAB
WV
Enumeration date
08/21/2007
Last updated
08/21/2007
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