Provider Demographics
NPI:1457084840
Name:NORTHERN WEST VIRGINIA CENTER FOR INDEPENDENT LIVING INC.
Entity Type:Organization
Organization Name:NORTHERN WEST VIRGINIA CENTER FOR INDEPENDENT LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-296-6091
Mailing Address - Street 1:601 E BROCKWAY AVE # 3
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-0106
Mailing Address - Country:US
Mailing Address - Phone:304-296-6091
Mailing Address - Fax:304-292-5217
Practice Address - Street 1:601 E BROCKWAY AVE # 3
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-0106
Practice Address - Country:US
Practice Address - Phone:304-296-6091
Practice Address - Fax:304-292-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable