MEDICARE: MAINSTREAM SERVICES, INCORPORATED

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
1	251B00000X	Case Management Agency	278	WV

Other Identifiers

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

General Provider Information

NPI Number	:	1902801426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINSTREAM SERVICES, INCORPORATED

Provider Business Mailing Address
First Line	:	4757C ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9703
Country	:	US
Telephone Number	:	304-522-1945
Fax Number	:	304-522-1946

Provider Business Practice Location Address
First Line	:	4757C ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9703
Country	:	US
Telephone Number	:	304-522-1945
Fax Number	:	304-522-1946

Authorized Official
Title or Position	:	SERVICE COORDINATOR
Name	:	MRS. DEANA PRINCE
Credential	:
Telephone Number	:	304-522-1945

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/22/2020

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Directions to “MAINSTREAM SERVICES, INCORPORATED ” Practice Location

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