Provider Demographics
NPI:1699171850
Name:FLORENCE CRITTENTON PROGRAMS
Entity type:Organization
Organization Name:FLORENCE CRITTENTON PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-242-7060
Mailing Address - Street 1:2606 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5370
Mailing Address - Country:US
Mailing Address - Phone:304-242-7060
Mailing Address - Fax:304-242-7076
Practice Address - Street 1:2584 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5368
Practice Address - Country:US
Practice Address - Phone:304-242-7060
Practice Address - Fax:304-242-7076
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORENCE CRITTENTON SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness