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General NPI Number Information
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NPI Number | 1154406296
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Entity Type | Organization
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Legal Business Name | POTOMAC COMPREHENSIVE DIAGNOSTIC AND GUIDANCE CENTER INC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | ONE BLUE STREET
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City | ROMNEY
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State | WV
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Zip | 26757
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Country | US
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Telephone | 304-822-3861
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Fax | 304-822-4297
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Provider Business Mailing Address
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Address Line | ONE BLUE STREET
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City | ROMNEY
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State | WV
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Zip | 26757
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Country | US
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Telephone | 304-822-3861
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Fax | 304-822-4297
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DAVID PLOWRIGHT
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Credential |
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Telephone | 304-822-3861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | WVDHHR214
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License Number State | WV
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