Provider Demographics
NPI:1669937744
Name:SOUTHWESTERN REGIONAL DAY REPORT CENTER
Entity type:Organization
Organization Name:SOUTHWESTERN REGIONAL DAY REPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-792-8689
Mailing Address - Street 1:1 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3965
Mailing Address - Country:US
Mailing Address - Phone:304-792-8689
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3965
Practice Address - Country:US
Practice Address - Phone:304-792-8689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children