Provider Demographics
NPI:1841308541
Name:PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INCORPORATED
Entity type:Organization
Organization Name:PRESTON-TAYLOR COMMUNITY HEALTH CENTERS INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-265-0312
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:725 N PIKE ST
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354
Mailing Address - Country:US
Mailing Address - Phone:304-265-0312
Mailing Address - Fax:304-265-0314
Practice Address - Street 1:711 N PIKE ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354
Practice Address - Country:US
Practice Address - Phone:304-265-4600
Practice Address - Fax:304-265-6008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTON-TAYLOR COMMUNITY HEALTH CENTERS, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0035347002Medicaid