MEDICARE: RALEIGH COUNTY COMMUNITY ACTION ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	AP00943630	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154673309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEIGH COUNTY COMMUNITY ACTION ASSOCIATION

Provider Business Mailing Address
First Line	:	PO BOX 3066
Second Line	:	111 WILLOW LANE
City	:	BECKLEY
State	:	WV
Zip	:	25801-1777
Country	:	US
Telephone Number	:	304-252-6396
Fax Number	:	304-255-9198

Provider Business Practice Location Address
First Line	:	111 WILLOW LN
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-5521
Country	:	US
Telephone Number	:	304-252-6396
Fax Number	:	304-255-9198

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MRS. CYNTHIA G HELTZEL
Credential	:	CPA
Telephone Number	:	304-252-6396

Provider Enumeration Date	:	10/12/2012
Last Update Date	:	10/12/2012

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