Provider Demographics
NPI:1174985717
Name:APPALACHIAN COMMUNITY DISABILITY CENTER
Entity type:Organization
Organization Name:APPALACHIAN COMMUNITY DISABILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-208-3715
Mailing Address - Street 1:3751 TEAYS VALLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9705
Mailing Address - Country:US
Mailing Address - Phone:304-302-2078
Mailing Address - Fax:304-302-7260
Practice Address - Street 1:3751 TEAYS VALLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9705
Practice Address - Country:US
Practice Address - Phone:304-302-2078
Practice Address - Fax:304-302-7260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23162423251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health