Full Name | |
---|---|
Speciality | Community/behavioral Health |
Location | 235 Woods Dr, St Albans, West Virginia |
Authorized Official Name and Position | Edward Donahue (CFO AND AUTHORIZED OFFICIAL) |
Authorized Official Contact | 9286684232 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
19820 N. 7th Street Suite 205, Attn: Finance Dept Phoenix AZ 85024-1688 Ph: (928) 684-4039 | 235 Woods Dr St Albans WV 25177 Ph: (304) 727-9768 |
NPI Number | 1952580698 |
---|---|
Provider Enumeration Date | 10/30/2007 |
Last Update Date | 10/04/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952580698 | NPI | - | NPPES |
3810001613 | Medicaid | WV |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 291 (West Virginia) | Primary |