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General NPI Number Information
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NPI Number | 1700166659
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Entity Type | Organization
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Legal Business Name | CARRUTH CENTER-SSC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 700 COLLEGE AVENUE 3RD FLOOR
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City | MORGANTOWN
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State | WV
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Zip | 26506-6422
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Country | US
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Telephone | 304-293-4431
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 780
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City | MORGANTOWN
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State | WV
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Zip | 26507-0780
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Country | US
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Telephone | 304-293-7401
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT SPECIALISTQ
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Name | ANDREA RUMBLE
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Credential |
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Telephone | 304-293-5033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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