| Pride Community Services, Inc. | |
|
699 Stratton St Logan WV 25601-4020 | |
| (304) 752-2686 | |
| (304) 752-1047 |
| Full Name | Pride Community Services, Inc. |
|---|---|
| Speciality | Technician - Attendant Care Provider |
| Location | 699 Stratton St, Logan, West Virginia |
| Authorized Official Name and Position | Reginald Jones (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3047526868 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pride Community Services, Inc. Po Box 1346 Logan WV 25601-1346 Ph: (304) 752-6868 | Pride Community Services, Inc. 699 Stratton St Logan WV 25601-4020 Ph: (304) 752-2686 |
| NPI Number | 1922374883 |
|---|---|
| Provider Enumeration Date | 03/26/2012 |
| Last Update Date | 04/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922374883 | NPI | - | NPPES |
| 3810022733 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| 3747A0650X | Technician - Attendant Care Provider | (* (Not Available)) | Primary |
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