Provider Demographics
NPI:1801011952
Name:CENTRAL WV COMMUNITY ACTION
Entity Type:Organization
Organization Name:CENTRAL WV COMMUNITY ACTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-622-8495
Mailing Address - Street 1:PO BOX 1070
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26302-1070
Mailing Address - Country:US
Mailing Address - Phone:304-622-8495
Mailing Address - Fax:304-622-4976
Practice Address - Street 1:106 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4259
Practice Address - Country:US
Practice Address - Phone:304-622-8495
Practice Address - Fax:304-622-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9030047000Medicaid