Provider Demographics
NPI:1386851509
Name:KANAWHA VALLEY CENTER INC
Entity Type:Organization
Organization Name:KANAWHA VALLEY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION AND HUMA
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-347-9818
Mailing Address - Street 1:200 BRADFORD STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-5301
Mailing Address - Country:US
Mailing Address - Phone:800-835-5277
Mailing Address - Fax:304-347-9820
Practice Address - Street 1:200 BRADFORD STREET
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-5301
Practice Address - Country:US
Practice Address - Phone:800-835-5277
Practice Address - Fax:304-347-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5200000000Medicaid