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General NPI Number Information
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NPI Number | 1104086503
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Entity Type | Organization
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Legal Business Name | CHARLES W. CAMMACK CHILDREN'S CENTER, INC.
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 64 6TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-1751
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Country | US
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Telephone | 304-523-3497
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Fax | 304-529-3882
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Provider Business Mailing Address
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Address Line | 64 6TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-1751
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Country | US
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Telephone | 304-523-3497
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Fax | 304-529-3882
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ANTHONY WARNICK
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Credential |
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Telephone | 304-523-3497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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