Provider Demographics
NPI:1083162796
Name:MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
Other - Org Name:MVA HEALTH CENTER - MANNINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDERGRIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-367-8740
Mailing Address - Street 1:118 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-1131
Mailing Address - Country:US
Mailing Address - Phone:304-986-1750
Mailing Address - Fax:304-986-3742
Practice Address - Street 1:118 MARKET ST
Practice Address - Street 2:
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-1131
Practice Address - Country:US
Practice Address - Phone:304-986-1750
Practice Address - Fax:304-986-3742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2016-013261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)