1346305315 NPI number — CLAY-BATTELLE HEALTH SERVICES ASSOCIATION

Table of content: (NPI 1346305315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346305315 NPI number — CLAY-BATTELLE HEALTH SERVICES ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLAY-BATTELLE HEALTH SERVICES ASSOCIATION
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:
6
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:
1346305315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 MAY LN STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26562-9669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-775-4671
Provider Business Mailing Address Fax Number:
304-775-4211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 HORNET HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26562-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-775-4671
Provider Business Practice Location Address Fax Number:
304-775-4211
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
304-432-8211

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X , with the licence number: 51D0236727 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0035288007 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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