Provider Demographics
NPI:1982024741
Name:COMMUNITY ACTION OF SOUTH EASTERN WV
Entity Type:Organization
Organization Name:COMMUNITY ACTION OF SOUTH EASTERN WV
Other - Org Name:CASEWV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ORAETTA
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:HUBBARF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-327-3501
Mailing Address - Street 1:307 FEDERAL ST
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3063
Mailing Address - Country:US
Mailing Address - Phone:304-327-3501
Mailing Address - Fax:304-487-8801
Practice Address - Street 1:600 TRENT STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740
Practice Address - Country:US
Practice Address - Phone:304-425-7111
Practice Address - Fax:304-487-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1048-1122251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health