Provider Demographics
NPI:1538331178
Name:CLAY CO. DEV
Entity Type:Organization
Organization Name:CLAY CO. DEV
Other - Org Name:TENDER HEART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-872-9115
Mailing Address - Street 1:812 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-2028
Mailing Address - Country:US
Mailing Address - Phone:304-872-9115
Mailing Address - Fax:304-872-9227
Practice Address - Street 1:812 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-2028
Practice Address - Country:US
Practice Address - Phone:304-872-9115
Practice Address - Fax:304-872-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21874703252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV33810011359Medicaid