Provider Demographics
NPI:1073219622
Name:VANCE FAMILY SERVICES
Entity Type:Organization
Organization Name:VANCE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:304-946-5017
Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:AMHERSTDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25607-0423
Mailing Address - Country:US
Mailing Address - Phone:304-946-5017
Mailing Address - Fax:
Practice Address - Street 1:114 HURLOCK LN
Practice Address - Street 2:
Practice Address - City:SLAB FORK
Practice Address - State:WV
Practice Address - Zip Code:25920-9523
Practice Address - Country:US
Practice Address - Phone:304-946-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty