| Harper Road Treatment Center Llc | |
|
1802 Harper Rd Ste 202 Beckley WV 25801 | |
| (681) 207-7389 | |
| Not Available |
| Full Name | Harper Road Treatment Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1802 Harper Rd Ste 202, Beckley, West Virginia |
| Authorized Official Name and Position | Prakash Puranik (PARTNER/OWNER) |
| Authorized Official Contact | 6812077389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harper Road Treatment Center Llc 1802 Harper Rd Ste 202 Beckley WV 25801-3376 Ph: (681) 207-7389 | Harper Road Treatment Center Llc 1802 Harper Rd Ste 202 Beckley WV 25801 Ph: (681) 207-7389 |
| NPI Number | 1356841100 |
|---|---|
| Provider Enumeration Date | 02/19/2018 |
| Last Update Date | 02/22/2022 |
| Certification Date | 02/22/2022 |
| Medicare PECOS PAC ID | 5395167159 |
|---|---|
| Medicare Enrollment ID | O20200624001001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356841100 | NPI | - | NPPES |
| Provider Name | Prakash Puranik |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1538270590 PECOS PAC ID: 4385544683 Enrollment ID: I20040114000331 |
| Provider Name | Deborah L Marra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700877644 PECOS PAC ID: 4082650767 Enrollment ID: I20050705000115 |
| Provider Name | Kristen Sisler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386289320 PECOS PAC ID: 2163841867 Enrollment ID: I20200930000374 |
| Provider Name | Michael Allen Beswick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164776589 PECOS PAC ID: 6406265719 Enrollment ID: I20210517001570 |
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