1255496220 NPI number — RSCR WEST VIRGINIA, INC.

Table of content: (NPI 1255496220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255496220 NPI number — RSCR WEST VIRGINIA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RSCR WEST VIRGINIA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY ALTERNATIVES WEST VIRGINIA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255496220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1207 QUARRIER ST
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25301-1826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-344-5795
Provider Business Mailing Address Fax Number:
304-344-5747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3702 CAMDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARKERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26101-6333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-485-6403
Provider Business Practice Location Address Fax Number:
304-865-6551
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DYE
Authorized Official First Name:
LESA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT & DIRECTOR
Authorized Official Telephone Number:
304-210-2481

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0005269000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com