Healthcare Provider Details

I. General information

NPI: 1508260647
Provider Name (Legal Business Name): COALFIELD COMMUNITY ACTION PARTNERSHIP, INC. (CM)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 W 3RD AVE
WILLIAMSON WV
25661-3007
US

IV. Provider business mailing address

PO BOX 1406
WILLIAMSON WV
25661-1406
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 Number
License Number State

VIII. Authorized Official

Name: MR. TIM SALMONS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-235-1701