Healthcare Provider Details

I. General information

NPI: 1578810636
Provider Name (Legal Business Name): COALFIELD COMMUNITY ACTION PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 ALDERSON STREET
WILLIAMSON WV
25661-3215
US

IV. Provider business mailing address

P.O. BOX 1406 815 ALDERSON STREET/
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 Code376J00000X
TaxonomyHomemaker
License Number10350857
License Number StateWV

VIII. Authorized Official

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