Provider Demographics
NPI:1629290127
Name:MARTINSBURG INSTITUTE INC
Entity Type:Organization
Organization Name:MARTINSBURG INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERCH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:304-263-1101
Mailing Address - Street 1:223 EAGLE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-3367
Mailing Address - Country:US
Mailing Address - Phone:304-263-1101
Mailing Address - Fax:304-263-0031
Practice Address - Street 1:223 EAGLE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3367
Practice Address - Country:US
Practice Address - Phone:304-263-1101
Practice Address - Fax:304-263-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCC0559017OtherBOARD OF PHARMACY LICENSE