Healthcare Provider Details

I. General information

NPI: 1013557982
Provider Name (Legal Business Name): MOUNTAINEER WELLNESS AND RECOVERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 GEORGE ST
BECKLEY WV
25801-2653
US

IV. Provider business mailing address

310 GEORGE ST
BECKLEY WV
25801-2653
US

V. Phone/Fax

Practice location:
  • Phone: 304-552-2261
  • Fax:
Mailing address:
  • Phone: 681-207-3652
  • Fax: 681-207-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER M MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 681-238-3344