Healthcare Provider Details

I. General information

NPI: 1306944236
Provider Name (Legal Business Name): MULBERRY STREET MANAGEMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 GREENBAG RD
MORGANTOWN WV
26508-1532
US

IV. Provider business mailing address

1097 GREENBAG RD
MORGANTOWN WV
26508-1532
US

V. Phone/Fax

Practice location:
  • Phone: 304-291-9066
  • Fax: 304-291-2119
Mailing address:
  • Phone: 304-291-9066
  • Fax: 304-291-2119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number310
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY S PLEVICH
Title or Position: CFO
Credential:
Phone: 304-291-9066