Healthcare Provider Details

I. General information

NPI: 1265791248
Provider Name (Legal Business Name): COALFIELD COMMUNITY ACTION PARTNERSHIP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 ALDERSON ST
WILLIAMSON WV
25661-3215
US

IV. Provider business mailing address

815 ALDERSON ST
WILLIAMSON WV
25661-3215
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-1701
  • Fax: 304-235-1706
Mailing address:
  • Phone: 304-235-1701
  • Fax: 304-235-1706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number10350857
License Number StateWV

VIII. Authorized Official

Name: MR. DAVID JEWELL
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 304-235-1701