| The Behavioral Health Pavilion Of The Virginias | |
|
122 12th Street Ext Princeton WV 24740-2352 | |
| (304) 487-7000 | |
| (304) 487-7370 |
| Full Name | The Behavioral Health Pavilion Of The Virginias |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 122 12th Street Ext, Princeton, West Virginia |
| Authorized Official Name and Position | Diane Lynn Spencer (VP OF FINANCE/CFO) |
| Authorized Official Contact | 3044877505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Behavioral Health Pavilion Of The Virginias Po Box 1369 Princeton WV 24740-1369 Ph: (304) 487-7000 | The Behavioral Health Pavilion Of The Virginias 122 12th Street Ext Princeton WV 24740-2352 Ph: (304) 487-7000 |
| NPI Number | 1619053329 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 12/08/2023 |
| Certification Date | 12/08/2023 |
| Medicare PECOS PAC ID | 3678482221 |
|---|---|
| Medicare Enrollment ID | O20070315000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619053329 | NPI | - | NPPES |
| 0001111001 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 104 (West Virginia) | Primary |
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