1366602039 NPI number — BOARD OF CHILD CARE, WV

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366602039 NPI number — BOARD OF CHILD CARE, WV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF CHILD CARE, WV
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:
Provider Other Organization Name Type Code:
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:
1366602039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
715 BROWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARTINSBURG
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25404-7282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-267-3300
Provider Business Mailing Address Fax Number:
304-274-1876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 BROWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25404-7282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-267-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CURCIO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-267-3300

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  06GRR043 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9301006000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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