Healthcare Provider Details

I. General information

NPI: 1659942217
Provider Name (Legal Business Name): PARKERSBURG ADDICTION RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 EMERSON AVE
PARKERSBURG WV
26104-2519
US

IV. Provider business mailing address

2910 EMERSON AVE
PARKERSBURG WV
26104-2519
US

V. Phone/Fax

Practice location:
  • Phone: 304-239-5355
  • Fax: 304-699-1923
Mailing address:
  • Phone: 304-239-5355
  • Fax: 304-699-1923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MERANDA SHANTEL MURPHY
Title or Position: CEO
Credential:
Phone: 304-239-5355