Healthcare Provider Details

I. General information

NPI: 1669141420
Provider Name (Legal Business Name): HIGH MEADOWS RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 N EISENHOWER DR
BECKLEY WV
25801-4137
US

IV. Provider business mailing address

PO BOX 883
SHADY SPRING WV
25918-0883
US

V. Phone/Fax

Practice location:
  • Phone: 304-237-2339
  • Fax:
Mailing address:
  • Phone: 304-237-2339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY STUMP
Title or Position: CEO/OWNER
Credential:
Phone: 304-237-2339