Provider Demographics
NPI:1518287051
Name:MOUNTAINEER CASE MANAGEMENT
Entity Type:Organization
Organization Name:MOUNTAINEER CASE MANAGEMENT
Other - Org Name:MOUNTAINEER CASE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSCRCLPC
Authorized Official - Phone:304-476-6698
Mailing Address - Street 1:1445 PARK SIDE EST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-6109
Mailing Address - Country:US
Mailing Address - Phone:304-476-6698
Mailing Address - Fax:
Practice Address - Street 1:1445 PARK SIDE EST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-6109
Practice Address - Country:US
Practice Address - Phone:304-476-6698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10211817251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management