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General NPI Number Information
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NPI Number | 1598338659
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL CARE CASE MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/17/2021
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Last Update Date | 07/17/2021
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Provider Practice Location Address
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Address Line | 19 MAIN ST
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City | ELKINS
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State | WV
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Zip | 26241-3125
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Country | US
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Telephone | 304-635-7740
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Fax | 304-635-7742
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Provider Business Mailing Address
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Address Line | 19 MAIN ST
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City | ELKINS
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State | WV
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Zip | 26241-3125
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Country | US
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Telephone | 304-635-7740
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Fax | 304-635-7742
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Authorized Official
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Title or Position | DIRECTOR
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Name | WENDY MICHELLE COLLINS
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Credential | RN
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Telephone | 304-635-7740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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