Provider Demographics
NPI:1508260837
Name:WV FAMILY SUPPORT AND REHABILITATION SERVICES
Entity Type:Organization
Organization Name:WV FAMILY SUPPORT AND REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:OGWUDE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CRC, LSW
Authorized Official - Phone:304-917-0021
Mailing Address - Street 1:214 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4615
Mailing Address - Country:US
Mailing Address - Phone:304-917-0021
Mailing Address - Fax:
Practice Address - Street 1:214 8TH ST.
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101
Practice Address - Country:US
Practice Address - Phone:304-917-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV410251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024714Medicaid