Healthcare Provider Details

I. General information

NPI: 1720356165
Provider Name (Legal Business Name): SENECA HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

IV. Provider business mailing address

131 WELLNESS DR
SUMMERSVILLE WV
26651-5402
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-2659
  • Fax: 304-872-1685
Mailing address:
  • Phone: 304-872-6503
  • Fax: 304-872-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number17
License Number StateWV

VIII. Authorized Official

Name: MRS. MARCIE L VAUGHAN
Title or Position: PRESIDENT CEO
Credential: LP
Phone: 304-872-6503