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3094 Charles Town Road Kearneysville WV 25430 | |
| (304) 901-2070 | |
| (304) 885-1054 |
| Full Name | |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 3094 Charles Town Road, Kearneysville, West Virginia |
| Authorized Official Name and Position | Jason Hendricks (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 1489400407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3094 Charles Town Road Kearneysville WV 25430 Ph: (304) 901-2070 | 3094 Charles Town Road Kearneysville WV 25430 Ph: (304) 901-2070 |
| NPI Number | 1780135863 |
|---|---|
| Provider Enumeration Date | 10/24/2016 |
| Last Update Date | 09/23/2024 |
| Certification Date | 09/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780135863 | NPI | - | NPPES |
| 443 | Other | WV | DEPARTMENT OF HEALTH AND HUMAN RESOURCES BEHAVIORAL HEALTH LICENSE |
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