Provider Demographics
NPI:1538283957
Name:SOUTHWESTERN COMMUNITY ACTION COUNCIL
Entity Type:Organization
Organization Name:SOUTHWESTERN COMMUNITY ACTION COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-525-5151
Mailing Address - Street 1:540 FIFTH AVE.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1908
Mailing Address - Country:US
Mailing Address - Phone:304-525-5151
Mailing Address - Fax:304-697-8556
Practice Address - Street 1:540 FIFTH AVE.
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1908
Practice Address - Country:US
Practice Address - Phone:304-525-5151
Practice Address - Fax:304-697-8556
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWESTERN COMMUNITY ACTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-19
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251E00000X, 251J00000X, 251X00000X, 253Z00000X, 376J00000X
WV251B0000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023584001Medicaid
WV3810018524Medicaid
WV0023584004Medicaid