| NPI | 1891063665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABITHA JEFFRIES Director 304-698-6081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: WV 22423229) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WV 27534) |
| 252Y00000X Early Intervention Provider Agency (Licence: WV 22423229) | |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2011-12-08 |