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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