=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245342823
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | W. J. COOK & ASSOCIATES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 01/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6720 CIRCLE CREEK DRIVE
-----------------------------------------------------
City | BOONES MILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24065-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-776-2858
-----------------------------------------------------
Fax | 540-776-3018
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 229
-----------------------------------------------------
City | BOONES MILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24065-0229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-776-2858
-----------------------------------------------------
Fax | 540-776-3018
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. WENDEL DARNELL COOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-776-2858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | SS248S
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------