Healthcare Provider Details

I. General information

NPI: 1003185687
Provider Name (Legal Business Name): UNITED SUMMIT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HOSPITAL PLZ
CLARKSBURG WV
26301-9316
US

IV. Provider business mailing address

6 HOSPITAL PLZ
CLARKSBURG WV
26301-9316
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-5661
  • Fax: 304-623-2180
Mailing address:
  • Phone: 304-623-5661
  • Fax: 304-623-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number20
License Number StateWV

VIII. Authorized Official

Name: LISA PRICE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 304-623-5661