Healthcare Provider Details

I. General information

NPI: 1619146446
Provider Name (Legal Business Name): SOUTHWESTERN COMMUNITY ACTION COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 5TH AVE
HUNTINGTON WV
25701-1908
US

IV. Provider business mailing address

540 5TH AVE
HUNTINGTON WV
25701-1908
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-5151
  • Fax: 304-697-8556
Mailing address:
  • Phone: 304-525-5151
  • Fax: 304-697-8556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number042376
License Number StateWV

VIII. Authorized Official

Name: MR. DWIGHT COBURN
Title or Position: CEO
Credential:
Phone: 304-525-5151