Healthcare Provider Details

I. General information

NPI: 1356152813
Provider Name (Legal Business Name): RWV TECHSOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WOODY SIMMONS DR
MILL CREEK WV
26280-0004
US

IV. Provider business mailing address

PO BOX 4
MILL CREEK WV
26280-0004
US

V. Phone/Fax

Practice location:
  • Phone: 304-510-8113
  • Fax: 304-313-4520
Mailing address:
  • Phone: 304-510-8113
  • Fax: 304-313-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT DEMOTTO JR.
Title or Position: FACILITY OWNER
Credential:
Phone: 304-510-8113