Provider Demographics
NPI:1912725235
Name:APPALACHIAN CHILD DEVELOPMENT AGENCY, LLC
Entity type:Organization
Organization Name:APPALACHIAN CHILD DEVELOPMENT AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-552-3257
Mailing Address - Street 1:1728 MASSEY CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-2619
Mailing Address - Country:US
Mailing Address - Phone:304-552-3257
Mailing Address - Fax:
Practice Address - Street 1:1728 MASSEY CIR
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-2619
Practice Address - Country:US
Practice Address - Phone:304-552-3257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency