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General NPI Number Information
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NPI Number | 1659370856
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Entity Type | Organization
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Legal Business Name | NICHOLAS COMMUNITY ACTION PARTNERSHIP, INC.
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1205 BROAD ST
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-1805
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Country | US
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Telephone | 304-872-1162
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Fax | 304-872-5796
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Provider Business Mailing Address
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Address Line | 1205 BROAD ST
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-1805
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Country | US
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Telephone | 304-872-1162
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Fax | 304-872-5796
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID A JARROLL
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Credential |
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Telephone | 304-872-1162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 020385
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License Number State | WV
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