Healthcare Provider Details

I. General information

NPI: 1770243941
Provider Name (Legal Business Name): THE CHILDREN'S HOME SOCIETY OF WEST VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 KANAWHA BLVD E
CHARLESTON WV
25301-3002
US

IV. Provider business mailing address

PO BOX 2942
CHARLESTON WV
25330-2942
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-0795
  • Fax: 304-346-1062
Mailing address:
  • Phone: 304-346-0795
  • Fax: 304-346-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY ARTHUR
Title or Position: CFO
Credential:
Phone: 304-346-0795