Provider Demographics
NPI:1518583194
Name:NUSKOOL SCHOLARS
Entity Type:Organization
Organization Name:NUSKOOL SCHOLARS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MA; EDS
Authorized Official - Phone:706-573-7725
Mailing Address - Street 1:4234 GRANDVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9105
Mailing Address - Country:US
Mailing Address - Phone:706-573-7725
Mailing Address - Fax:681-207-1037
Practice Address - Street 1:109 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4627
Practice Address - Country:US
Practice Address - Phone:304-250-4210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1417468745Medicaid