Provider Demographics
NPI:1043417975
Name:MARTINSBURG WORK CENTER LLC
Entity Type:Organization
Organization Name:MARTINSBURG WORK CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KOONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-262-9600
Mailing Address - Street 1:PO BOX 1265
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1265
Mailing Address - Country:US
Mailing Address - Phone:304-262-9600
Mailing Address - Fax:304-262-6900
Practice Address - Street 1:24 INTEGRITY TER
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3524
Practice Address - Country:US
Practice Address - Phone:304-262-9600
Practice Address - Fax:304-262-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities