Provider Demographics
NPI:1912162082
Name:HARRISON COUNTY SOCIETY FOR CRIPPLED CHILDREN AND ADULTS
Entity Type:Organization
Organization Name:HARRISON COUNTY SOCIETY FOR CRIPPLED CHILDREN AND ADULTS
Other - Org Name:CHILDRENS TREATMENT CTR AND ADULT THERAPY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-624-5009
Mailing Address - Street 1:171LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-0000
Mailing Address - Country:US
Mailing Address - Phone:304-624-5009
Mailing Address - Fax:304-624-5107
Practice Address - Street 1:171LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-0000
Practice Address - Country:US
Practice Address - Phone:304-624-5009
Practice Address - Fax:304-624-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001801Medicaid