Provider Demographics
NPI:1124636832
Name:GRIFFITH, SANDRA L (PROGRAM DIRECTOR)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PROGRAM DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:ALUM CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25003-0285
Mailing Address - Country:US
Mailing Address - Phone:304-906-0279
Mailing Address - Fax:
Practice Address - Street 1:1611 CHARLESTON ROAD
Practice Address - Street 2:
Practice Address - City:POCA
Practice Address - State:WV
Practice Address - Zip Code:25159
Practice Address - Country:US
Practice Address - Phone:304-769-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant