Healthcare Provider Details

I. General information

NPI: 1235354879
Provider Name (Legal Business Name): DAVIS-STUART, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 188A
LEWISBURG WV
24901-9320
US

IV. Provider business mailing address

RR 2 BOX 188A
LEWISBURG WV
24901-9320
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-5577
  • Fax: 304-647-5727
Mailing address:
  • Phone: 304-647-5577
  • Fax: 304-647-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number186
License Number StateWV

VIII. Authorized Official

Name: MR. MARK A SPANGLER
Title or Position: EX. DIRECTOR
Credential: MA, LPC
Phone: 304-647-5577