Healthcare Provider Details

I. General information

NPI: 1184123705
Provider Name (Legal Business Name): HARRISON COUNTY COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S 3RD ST
CLARKSBURG WV
26301-0018
US

IV. Provider business mailing address

215 S 3RD ST
CLARKSBURG WV
26301-0018
US

V. Phone/Fax

Practice location:
  • Phone: 304-423-7061
  • Fax:
Mailing address:
  • Phone: 304-423-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateWV

VIII. Authorized Official

Name: GARY M HAMRICK
Title or Position: DIRECTOR
Credential:
Phone: 304-423-7061