Provider Demographics
NPI:1457451627
Name:COMMUNITY ACTION SOUTH EASTERN WV
Entity Type:Organization
Organization Name:COMMUNITY ACTION SOUTH EASTERN WV
Other - Org Name:CASE WV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-323-8398
Mailing Address - Street 1:307 FEDERAL ST
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3063
Mailing Address - Country:US
Mailing Address - Phone:304-327-3506
Mailing Address - Fax:304-327-8822
Practice Address - Street 1:307 FEDERAL ST
Practice Address - Street 2:SUITE 323
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3063
Practice Address - Country:US
Practice Address - Phone:304-323-8398
Practice Address - Fax:304-324-8791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV93564OtherUNICARE PROVIDER NUMBER
WV3810004732Medicaid