Provider Demographics
NPI:1528381746
Name:JACKSON COUNTY DEVELOPMENTAL CENTER, INC
Entity Type:Organization
Organization Name:JACKSON COUNTY DEVELOPMENTAL CENTER, INC
Other - Org Name:JCDC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GREENING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-273-9311
Mailing Address - Street 1:270 JACK BURLINGAME DR
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25262-8576
Mailing Address - Country:US
Mailing Address - Phone:304-273-9311
Mailing Address - Fax:304-273-5131
Practice Address - Street 1:270 JACK BURLINGAME DR
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:WV
Practice Address - Zip Code:25262-8576
Practice Address - Country:US
Practice Address - Phone:304-273-9311
Practice Address - Fax:304-273-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV406251B00000X, 251C00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care