Healthcare Provider Details

I. General information

NPI: 1750424909
Provider Name (Legal Business Name): SOLACIUM ALLREDGE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 32 WILLIAM AVENUE
DAVIS WV
26260
US

IV. Provider business mailing address

RT. #3 WILLIAM AVENUE
DAVIS WV
26260
US

V. Phone/Fax

Practice location:
  • Phone: 304-259-2262
  • Fax:
Mailing address:
  • Phone: 304-259-2262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number805668
License Number StateWV

VIII. Authorized Official

Name: JIM BROWNING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-259-2262