| NPI | 1285789537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA LYNN ROBERTSON Benefits Coordinator 304-792-7130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: WV 11) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2020-01-30 |