Provider Demographics
NPI:1124369780
Name:COMMUNITY HEALTH ASSOCIATION
Entity Type:Organization
Organization Name:COMMUNITY HEALTH ASSOCIATION
Other - Org Name:JGH THERAPY AND SPORTSCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-373-1475
Mailing Address - Street 1:511 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1733
Mailing Address - Country:US
Mailing Address - Phone:304-273-5648
Mailing Address - Fax:
Practice Address - Street 1:511 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1733
Practice Address - Country:US
Practice Address - Phone:304-273-5648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy