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NPI Code Detail

MEDICARE: NICHOLAS COMMUNITY ACTION PARTNERSHIP, INC.

MEDICARE: NICHOLAS COMMUNITY ACTION PARTNERSHIP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1305S00000XPoint of Service020385WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659370856
Entity Type Code : Organization
Provider Name (Legal Business Name) : NICHOLAS COMMUNITY ACTION PARTNERSHIP, INC.
Provider Business Mailing Address
First Line : 1205 BROAD ST
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-1805
Country : US
Telephone Number : 304-872-1162
Fax Number : 304-872-5796
Provider Business Practice Location Address
First Line : 1205 BROAD ST
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-1805
Country : US
Telephone Number : 304-872-1162
Fax Number : 304-872-5796
Authorized Official
Title or Position : PRESIDENT
Name : MR. DAVID A JARROLL
Credential :
Telephone Number : 304-872-1162
Provider Enumeration Date : 07/19/2005
Last Update Date : 08/22/2020

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Directions to “NICHOLAS COMMUNITY ACTION PARTNERSHIP, INC. ” Practice Location

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