Healthcare Provider Details

I. General information

NPI: 1043339906
Provider Name (Legal Business Name): CHILDREN'S HOME SOCIETY OF WEST VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 KANAWHA BLVD E
CHARLESTON WV
25301-3002
US

IV. Provider business mailing address

1422 KANAWHA BLVD E
CHARLESTON WV
25301-3002
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 Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number06GRR005
License Number StateWV

VIII. Authorized Official

Name: KIMBERLY C. ARTHUR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 304-346-0795