Provider Demographics
NPI:1215215496
Name:METROPOLITAN COMMUNITY DEVELOPMENT CORPORATION, INC.
Entity Type:Organization
Organization Name:METROPOLITAN COMMUNITY DEVELOPMENT CORPORATION, INC.
Other - Org Name:MCDC, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PASTOR DARIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:304-342-4775
Mailing Address - Street 1:205 DONNALLY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1122
Mailing Address - Country:US
Mailing Address - Phone:304-342-4775
Mailing Address - Fax:304-342-4799
Practice Address - Street 1:205 DONNALLY ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1122
Practice Address - Country:US
Practice Address - Phone:304-342-4775
Practice Address - Fax:304-342-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1916971343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015481Medicaid