Provider Demographics
NPI:1154673309
Name:RALEIGH COUNTY COMMUNITY ACTION ASSOCIATION
Entity Type:Organization
Organization Name:RALEIGH COUNTY COMMUNITY ACTION ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HELTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:304-252-6396
Mailing Address - Street 1:PO BOX 3066
Mailing Address - Street 2:111 WILLOW LANE
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-1777
Mailing Address - Country:US
Mailing Address - Phone:304-252-6396
Mailing Address - Fax:304-255-9198
Practice Address - Street 1:111 WILLOW LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-5521
Practice Address - Country:US
Practice Address - Phone:304-252-6396
Practice Address - Fax:304-255-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00943630251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0146263000Medicaid