| NPI | 1770984049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER BURNER Administrator 304-457-1670 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WV 123) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2024-09-01 |