Provider Demographics
NPI:1699127829
Name:WEST VIRGINIA REHABILITATION CENTERS
Entity type:Organization
Organization Name:WEST VIRGINIA REHABILITATION CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCADC
Authorized Official - Phone:606-369-4617
Mailing Address - Street 1:6775 POINT PLEASANT RD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25262-8100
Mailing Address - Country:US
Mailing Address - Phone:606-369-4617
Mailing Address - Fax:
Practice Address - Street 1:6775 POINT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:WV
Practice Address - Zip Code:25262-8100
Practice Address - Country:US
Practice Address - Phone:606-369-4617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility