Provider Demographics
NPI:1598911638
Name:PRESTON COUNTY SHELTERED WORKSHIP, INC
Entity Type:Organization
Organization Name:PRESTON COUNTY SHELTERED WORKSHIP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-864-6446
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26547
Mailing Address - Country:US
Mailing Address - Phone:304-864-6446
Mailing Address - Fax:304-864-6447
Practice Address - Street 1:RT 92 S JENNMAR ROAD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26547
Practice Address - Country:US
Practice Address - Phone:304-864-6446
Practice Address - Fax:304-864-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3604000-000Medicaid
WV3604000-000Medicaid