=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528210689
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TASK FORCE ON DEOMESTIC VIOLENCE, 'HOPE, INC'
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2008
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 JACKSON STREET
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-367-1100
-----------------------------------------------------
Fax | 304-367-0362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 626
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-367-1100
-----------------------------------------------------
Fax | 304-367-0362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCIAL MANAGER
-----------------------------------------------------
Name | MRS. HARRIET MILLER SUTTON
-----------------------------------------------------
Credential | MSW, ACSW
-----------------------------------------------------
Telephone | 304-367-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------