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General NPI Number Information
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NPI Number | 1003735879
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Entity Type | Organization
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Legal Business Name | BOOMTOWN MENTAL WELLNESS CENTER
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Dates
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Enumeration Date | 07/14/2026
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Last Update Date | 07/14/2026
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Provider Practice Location Address
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Address Line | 4002 FIRST AVENUE
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City | NITRO
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State | WV
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Zip | 25143-2339
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Country | US
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Telephone | 304-415-1551
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Fax |
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Provider Business Mailing Address
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Address Line | 1458 SATTES CIR
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City | NITRO
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State | WV
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Zip | 25143-2339
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Country | US
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Telephone | 304-415-1551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SARAH ELLEN DEAN
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Credential |
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Telephone | 304-415-1551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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