Basic Information
| Provider Information | |||||||||
| NPI: | 1629299581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTINGTON TREATMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 135 4TH AVE | ||||||||
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| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045255691 | ||||||||
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| Address1: | 135 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257011219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045255691 | ||||||||
| FaxNumber: | 3045255693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 09/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | MORGAN | ||||||||
| AuthorizedOfficialFirstName: | CONNIE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3045290386 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | NURSE PRACTITIONER | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 38147 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 38147 | 01 | WV | STATE LICENSURE | OTHER |