Provider Demographics
NPI:1235354879
Name:DAVIS-STUART, INC.
Entity Type:Organization
Organization Name:DAVIS-STUART, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPANGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:304-647-5577
Mailing Address - Street 1:RR 2 BOX 188A
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9320
Mailing Address - Country:US
Mailing Address - Phone:304-647-5577
Mailing Address - Fax:304-647-5727
Practice Address - Street 1:RR 2 BOX 188A
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9320
Practice Address - Country:US
Practice Address - Phone:304-647-5577
Practice Address - Fax:304-647-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV186322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0158860000Medicaid
WV30004935OtherSOCIAL SERVICES (WVDHHR)