Provider Demographics
NPI:1710429899
Name:SOUTHWESTERN COMMUNITY ACTION COUNCIL INC.
Entity Type:Organization
Organization Name:SOUTHWESTERN COMMUNITY ACTION COUNCIL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-525-5151
Mailing Address - Street 1:540 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1908
Mailing Address - Country:US
Mailing Address - Phone:304-525-5151
Mailing Address - Fax:
Practice Address - Street 1:540 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1908
Practice Address - Country:US
Practice Address - Phone:304-525-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023584001Medicaid
WV0023584004Medicaid