Provider Demographics
NPI:1154864411
Name:SOUTHWESTERN REGIONAL DAY REPORT CENTER
Entity Type:Organization
Organization Name:SOUTHWESTERN REGIONAL DAY REPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCC
Authorized Official - Phone:304-792-8648
Mailing Address - Street 1:1 WASHINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3900
Practice Address - Country:US
Practice Address - Phone:304-792-8689
Practice Address - Fax:304-792-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty