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General NPI Number Information
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NPI Number | 1982024741
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Entity Type | Organization
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Legal Business Name | COMMUNITY ACTION OF SOUTH EASTERN WV
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 600 TRENT STREET
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City | PRINCETON
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State | WV
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Zip | 24740
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Country | US
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Telephone | 304-425-7111
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Fax | 304-487-8801
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Provider Business Mailing Address
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Address Line | 307 FEDERAL ST SUITE 323
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City | BLUEFIELD
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State | WV
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Zip | 24701-3063
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Country | US
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Telephone | 304-327-3501
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Fax | 304-487-8801
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ORAETTA KENNEDY HUBBARF
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Credential |
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Telephone | 304-327-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1048-1122
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License Number State | WV
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