Premium Martial Arts WV LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

PREMIUM MARTIAL ARTS WV LLC

Practice address

963 Dunbar Village PLZ
Dunbar, WV 25064-3137

Phone

(304) 807-0251

NPI assigned

Feb 26, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Lynn Madden

Title

Owner/Instructor

Phone

(304) 807-0251

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551139200000",
    "number": "1083171078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 CROSSROADS VLG",
            "city": "NITRO",
            "state": "WV",
            "postal_code": "251432054",
            "telephone_number": "304-807-0251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "963 DUNBAR VILLAGE PLZ",
            "city": "DUNBAR",
            "state": "WV",
            "postal_code": "250643137",
            "telephone_number": "304-807-0251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM MARTIAL ARTS WV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-26",
        "last_updated": "2019-02-26",
        "status": "A",
        "authorized_official_last_name": "MADDEN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OWNER/INSTRUCTOR",
        "authorized_official_telephone_number": "304-807-0251"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Developmentally Disabled Services Day Training Agency in Dunbar, WV
• Providers in Dunbar, WV by specialty
• Developmentally Disabled Services Day Training Agency in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.