Healthcare Provider Details
I. General information
NPI: 1063179521
Provider Name (Legal Business Name): ANCHOR PROJECT SUN VALLEY INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/19/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3455 ROUTE 75
HUNTINGTON WV
25704-9008
US
IV. Provider business mailing address
2333 MACCORKLE AVE STE 100
SAINT ALBANS WV
25177-2073
US
V. Phone/Fax
- Phone: 304-419-7252
- Fax: 800-507-2033
- Phone: 304-419-7252
- Fax: 800-507-2033
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 324500000X |
| Taxonomy | Substance Abuse Rehabilitation Facility |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 323P00000X |
| Taxonomy | Psychiatric Residential Treatment Facility |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
WESLEY
A
WOOD
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, ADC
Phone: 304-419-7252