Healthcare Provider Details

I. General information

NPI: 1629299581
Provider Name (Legal Business Name): HUNTINGTON TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 4TH AVE
HUNTINGTON WV
25701-1219
US

IV. Provider business mailing address

135 4TH AVE
HUNTINGTON WV
25701-1219
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-5691
  • Fax: 304-525-5693
Mailing address:
  • Phone: 304-525-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38147
License Number StateWV

VIII. Authorized Official

Name: MRS. CONNIE M MORGAN
Title or Position: NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 304-529-0386