Provider Demographics
NPI:1629226519
Name:WORTHINGTON CENTER INC
Entity Type:Organization
Organization Name:WORTHINGTON CENTER INC
Other - Org Name:WORTHINGTON CENTER INC REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-485-5185
Mailing Address - Street 1:3199 CORE RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-1557
Mailing Address - Country:US
Mailing Address - Phone:304-485-5185
Mailing Address - Fax:304-485-0051
Practice Address - Street 1:3199 CORE RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-1557
Practice Address - Country:US
Practice Address - Phone:304-485-5185
Practice Address - Fax:304-485-0051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9255472Medicare PIN