Provider Demographics
NPI:1376902122
Name:MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MONONGAHELA VALLEY ASSOCIATION OF HEALTH CENTER, INC.
Other - Org Name:MONONGAH MIDDLE SCHOOL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDERGRIFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-367-8740
Mailing Address - Street 1:550 CAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MONONGAH
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1105
Mailing Address - Country:US
Mailing Address - Phone:304-367-2164
Mailing Address - Fax:304-366-9529
Practice Address - Street 1:550 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:MONONGAH
Practice Address - State:WV
Practice Address - Zip Code:26554-1105
Practice Address - Country:US
Practice Address - Phone:304-367-2164
Practice Address - Fax:304-366-9529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5119231Medicare Oscar/Certification