Provider Demographics
NPI:1205183365
Name:COALFIELD COMMUNITY ACTION PARTNERS
Entity Type:Organization
Organization Name:COALFIELD COMMUNITY ACTION PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-235-1701
Mailing Address - Street 1:P.O. BOX 1406
Mailing Address - Street 2:815 ALDERSON STREET/
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3215
Mailing Address - Country:US
Mailing Address - Phone:304-235-1701
Mailing Address - Fax:304-235-1706
Practice Address - Street 1:815 ALDERSON STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3215
Practice Address - Country:US
Practice Address - Phone:304-235-1701
Practice Address - Fax:304-235-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10350857171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016846Medicaid