Provider Demographics
NPI: | 1760176465 |
---|---|
Name: | SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, INC. |
Entity Type: | Organization |
Organization Name: | SOUTHERN HIGHLANDS COMMUNITY MENTAL HEALTH CENTER, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANGELA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PETERSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 304-425-9541 |
Mailing Address - Street 1: | 200 12TH STREET EXT |
Mailing Address - Street 2: | |
Mailing Address - City: | PRINCETON |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 24740-2329 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 304-425-9541 |
Mailing Address - Fax: | 681-282-5558 |
Practice Address - Street 1: | 200 12TH STREET EXT |
Practice Address - Street 2: | |
Practice Address - City: | PRINCETON |
Practice Address - State: | WV |
Practice Address - Zip Code: | 24740-2329 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-425-9541 |
Practice Address - Fax: | 681-282-5558 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-06-06 |
Last Update Date: | 2023-06-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty |