Provider Demographics
NPI:1649457367
Name:BUCKHANNON-UPSHUR WORK ADJUSTMENT CENTER,INC.
Entity type:Organization
Organization Name:BUCKHANNON-UPSHUR WORK ADJUSTMENT CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-472-4678
Mailing Address - Street 1:RR 2 BOX 62
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-9503
Mailing Address - Country:US
Mailing Address - Phone:304-472-4678
Mailing Address - Fax:304-472-4712
Practice Address - Street 1:RR 2 BOX 62
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-9503
Practice Address - Country:US
Practice Address - Phone:304-472-4678
Practice Address - Fax:304-472-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3606005000Medicaid