Healthcare Provider Details

I. General information

NPI: 1255548186
Provider Name (Legal Business Name): MARTIN BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MARKET ST
PARKERSBURG WV
26101-5150
US

IV. Provider business mailing address

521 MARKET ST BOX 1
PARKERSBURG WV
26101-5150
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-3457
  • Fax: 304-422-1025
Mailing address:
  • Phone: 304-424-3457
  • Fax: 304-422-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number1011-4283
License Number StateWV

VIII. Authorized Official

Name: MR. THOMAS RICHARD MARTIN
Title or Position: PRESIDENT
Credential: BA
Phone: 304-424-3457