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General NPI Number Information
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NPI Number | 1205165347
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Entity Type | Organization
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Legal Business Name | POTOMAC HIGHLANDS GUILD
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 7 MOUNTAIN VIEW ST
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City | PETERSBURG
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State | WV
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Zip | 26847-1796
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Country | US
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Telephone | 304-257-1555
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Fax | 304-257-1945
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Provider Business Mailing Address
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Address Line | 7 MOUNTAIN VIEW ST
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City | PETERSBURG
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State | WV
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Zip | 26847-1796
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Country | US
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Telephone | 130-425-7115
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Fax | 304-257-1945
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Authorized Official
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Title or Position | A/R OFFICER
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Name | MRS. CAROL D HENDRIX
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Credential |
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Telephone | 304-257-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1036-8848
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License Number State | WV
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