Healthcare Provider Details

I. General information

NPI: 1649457367
Provider Name (Legal Business Name): BUCKHANNON-UPSHUR WORK ADJUSTMENT CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 62
BUCKHANNON WV
26201-9503
US

IV. Provider business mailing address

RR 2 BOX 62
BUCKHANNON WV
26201-9503
US

V. Phone/Fax

Practice location:
  • Phone: 304-472-4678
  • Fax: 304-472-4712
Mailing address:
  • Phone: 304-472-4678
  • Fax: 304-472-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LEROY E. DIXON JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-472-4678