| Alta Vista Children's Shelter | |
|
261 Haymond Hwy Clarksburg WV 26301-3868 | |
| (304) 622-3339 | |
| (304) 622-3433 |
| Full Name | Alta Vista Children's Shelter |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 261 Haymond Hwy, Clarksburg, West Virginia |
| Authorized Official Name and Position | Matt Rudder (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3046221907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Alta Vista Children's Shelter 261 Haymond Hwy Clarksburg WV 26301-3868 Ph: (304) 622-3339 | Alta Vista Children's Shelter 261 Haymond Hwy Clarksburg WV 26301-3868 Ph: (304) 622-3339 |
| NPI Number | 1932318086 |
|---|---|
| Provider Enumeration Date | 05/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932318086 | NPI | - | NPPES |
| 0902105000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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