| Partnership Of African American Churches Inc. | |
|
1514 Kanawha Blvd W Charleston WV 25387-2533 | |
| (304) 768-7688 | |
| (304) 768-7647 |
| Full Name | Partnership Of African American Churches Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1514 Kanawha Blvd W, Charleston, West Virginia |
| Authorized Official Name and Position | Edna Green (ASSOCIATE DIRECTOR OPERATIONS) |
| Authorized Official Contact | 3047687688 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Partnership Of African American Churches Inc. Po Box 452 Institute WV 25112-0452 Ph: (304) 768-7688 | Partnership Of African American Churches Inc. 1514 Kanawha Blvd W Charleston WV 25387-2533 Ph: (304) 768-7688 |
| NPI Number | 1679060420 |
|---|---|
| Provider Enumeration Date | 04/17/2018 |
| Last Update Date | 10/19/2020 |
| Certification Date | 10/19/2020 |
| Medicare PECOS PAC ID | 6800216466 |
|---|---|
| Medicare Enrollment ID | O20201020002145 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679060420 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jeffrey V Ashley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013019280 PECOS PAC ID: 6406880806 Enrollment ID: I20050926000046 |
| Provider Name | Andy R Tanner |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689776387 PECOS PAC ID: 2466487327 Enrollment ID: I20050929000004 |
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