Provider Demographics
NPI:1265259717
Name:BOARD OF CHILD CARE OF THE UNITED METHODIST CHURCH INC
Entity type:Organization
Organization Name:BOARD OF CHILD CARE OF THE UNITED METHODIST CHURCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:304-267-3300
Mailing Address - Street 1:715 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-7282
Mailing Address - Country:US
Mailing Address - Phone:304-267-3300
Mailing Address - Fax:
Practice Address - Street 1:715 BROWN RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7282
Practice Address - Country:US
Practice Address - Phone:304-267-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF CHILD CARE OF THE UNITED METHODIST CHURCH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD056790600Medicaid
MD300222500Medicaid
WV3810026072Medicaid
MD479100200Medicaid
WV9301006000Medicaid