=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265791248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COALFIELD COMMUNITY ACTION PARTNERSHIP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2012
-----------------------------------------------------
Last Update Date | 05/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 ALDERSON ST
-----------------------------------------------------
City | WILLIAMSON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25661-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-235-1701
-----------------------------------------------------
Fax | 304-235-1706
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 ALDERSON ST
-----------------------------------------------------
City | WILLIAMSON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25661-3215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-235-1701
-----------------------------------------------------
Fax | 304-235-1706
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF FINANCE
-----------------------------------------------------
Name | MR. DAVID JEWELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 304-235-1701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 10350857
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------