Healthcare Provider Details

I. General information

NPI: 1649265455
Provider Name (Legal Business Name): PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N PIKE ST
GRAFTON WV
26354-1270
US

IV. Provider business mailing address

PO BOX 399 PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INC
GRAFTON WV
26354-0399
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-4909
  • Fax: 304-265-4916
Mailing address:
  • Phone: 304-265-0312
  • Fax: 304-265-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LINDA M SHRIVER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 304-265-0312