Healthcare Provider Details

I. General information

NPI: 1427477934
Provider Name (Legal Business Name): VALLEY COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SCOTT AVE
MORGANTOWN WV
26508-8804
US

IV. Provider business mailing address

301 SCOTT AVE
MORGANTOWN WV
26508-8804
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-1731
  • Fax:
Mailing address:
  • Phone: 304-296-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number21
License Number StateWV

VIII. Authorized Official

Name: CHERYL L PERONE
Title or Position: CEO
Credential:
Phone: 304-296-1731