NPIMap

Organization Active NPI

MSRC, LLC

Doing business as Mountain State Recovery Center

  • Community/Behavioral Health Agency
  • Charleston, WV
National Provider Identifier
1194294587
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MSRC, LLC
Doing business as
Mountain State Recovery Center
Practice address
102 Patrick Street PLZ
Charleston, WV 25387-2444
Phone
(304) 941-9779
NPI assigned
Nov 15, 2018
Last updated
Mar 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Authorized official

Name
Joseph ShafferNPI 1043608326
Title
Coo
Phone
(859) 489-2705

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

102 Patrick Street PLZ
Charleston, WV 25387-2444

Mailing address

8 River Walk Mall
South Charleston, WV 25303-1026

Other practice location 1

650 Washington Ave
Huntington, WV 25701-1042
Phone (304) 233-3200

Other names 1

  • Mountain State Recovery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251103002648 WV Part B Supplier - Clinic/Group Practice 6800122896 Receives reassigned benefits from 8 practitioners
Practice locations: Huntington, WV; Charleston, WV

National Provider Directory

National Provider Directory
Tax ID family
Mountain State Recovery Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

  • MSRC, LLC

    dba Mountain State Recovery Center

    • Methadone Clinic
    • Charleston, WV
    • NPI 1982268405
    NPD tax ID

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1194294587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 RIVER WALK MALL",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 PATRICK STREET PLZ",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253872444",
            "telephone_number": "304-941-9779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Huntington",
            "state": "WV",
            "postal_code": "257011042",
            "country_code": "US",
            "telephone_number": "304-233-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MSRC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-15",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "859-489-2705"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain State Recovery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.