NPIMap

Organization Active NPI

Mulberry Street Management Services, Inc.

  • Community/Behavioral Health Agency
  • Morgantown, WV
National Provider Identifier
1164614301
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MULBERRY STREET MANAGEMENT SERVICES, INC.
Practice address
1097 Greenbag Rd
Morgantown, WV 26508-1532
Phone
(304) 291-9066
Fax
(304) 291-2119
NPI assigned
Aug 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Authorized official

Name
Ms. Mary S Plevich
Title
Cfo
Phone
(304) 291-9066

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1097 Greenbag Rd
Morgantown, WV 26508-1532

Mailing address

1097 Greenbag Rd
Morgantown, WV 26508-1532
Phone (304) 291-9066

Other identifiers 1

IdentifierTypeStateIssuer
0030447000MedicaidWV

Other names 1

  • Coordinating Council for Independent Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mulberry Street Management Services Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1164614301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1097 GREENBAG RD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265081532",
            "telephone_number": "304-291-9066",
            "fax_number": "304-291-2119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1097 GREENBAG RD",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265081532",
            "telephone_number": "304-291-9066",
            "fax_number": "304-291-2119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULBERRY STREET MANAGEMENT SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-13",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "PLEVICH",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-291-9066",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0030447000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coordinating Council for Independent Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morgantown, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; 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.