| Mountaineer Life Enrichment Center, Llc | |
|
1522 Bunner Ridge Rd Fairmont WV 26554-5079 | |
| (304) 373-4678 | |
| Not Available |
| Full Name | Mountaineer Life Enrichment Center, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1522 Bunner Ridge Rd, Fairmont, West Virginia |
| Authorized Official Name and Position | Charles Sears (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 3043734678 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountaineer Life Enrichment Center, Llc 1522 Bunner Ridge Rd Fairmont WV 26554-5079 Ph: (304) 373-4678 | Mountaineer Life Enrichment Center, Llc 1522 Bunner Ridge Rd Fairmont WV 26554-5079 Ph: (304) 373-4678 |
| NPI Number | 1275232043 |
|---|---|
| Provider Enumeration Date | 03/01/2023 |
| Last Update Date | 03/01/2023 |
| Certification Date | 03/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275232043 | NPI | - | NPPES |
| 00000 | Other | SELF PAY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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