Healthcare Provider Details

I. General information

NPI: 1629290127
Provider Name (Legal Business Name): MARTINSBURG INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/30/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 EAGLE SCHOOL RD
MARTINSBURG WV
25404-3367
US

IV. Provider business mailing address

223 EAGLE SCHOOL RD
MARTINSBURG WV
25404-3367
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-1101
  • Fax: 304-263-0031
Mailing address:
  • Phone: 304-263-1101
  • Fax: 304-263-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: NEAL BERCH
Title or Position: EXECUTIVE DIRECTOR
Credential: BS
Phone: 304-263-1101