Provider Demographics
NPI:1235311044
Name:PRINCETON COMMUNITY HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:PRINCETON COMMUNITY HOSPITAL ASSOCIATION, INC.
Other - Org Name:PCH BEHAVIORAL MEDICINE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:VP OF FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-487-7505
Mailing Address - Street 1:122 12TH STREET EXTENSION
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2352
Mailing Address - Country:US
Mailing Address - Phone:304-487-7000
Mailing Address - Fax:304-487-7370
Practice Address - Street 1:122 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2352
Practice Address - Country:US
Practice Address - Phone:304-487-7000
Practice Address - Fax:304-487-7370
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINCETON COMMUNITY HOSPITAL ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-04
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001111002Medicaid