Provider Demographics
NPI:1609299908
Name:PRESTON HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:PRESTON HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-441-2001
Mailing Address - Street 1:1343 N PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-7633
Mailing Address - Country:US
Mailing Address - Phone:304-441-2001
Mailing Address - Fax:304-441-2009
Practice Address - Street 1:1343 N PRESTON HWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-7633
Practice Address - Country:US
Practice Address - Phone:304-441-2001
Practice Address - Fax:304-441-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2232-1458261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018394OtherWEST VIRGINIA MEDICAID FAMILY PLANNING