Healthcare Provider Details

I. General information

NPI: 1699127829
Provider Name (Legal Business Name): WEST VIRGINIA REHABILITATION CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 POINT PLEASANT RD
MILLWOOD WV
25262-8100
US

IV. Provider business mailing address

6775 POINT PLEASANT RD
MILLWOOD WV
25262-8100
US

V. Phone/Fax

Practice location:
  • Phone: 606-369-4617
  • Fax:
Mailing address:
  • Phone: 606-369-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN D FERGUSON
Title or Position: MEMBER
Credential: LCADC
Phone: 606-369-4617