NPIMap

Organization Active NPI

Potomac Highlands Guild

  • Community/Behavioral Health Agency
  • Petersburg, WV
National Provider Identifier
1205165347
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1036-8848 Issued in WV
Legal business name
POTOMAC HIGHLANDS GUILD
Practice address
7 Mountain View St
Petersburg, WV 26847-1796
Phone
(304) 257-1555
Fax
(304) 257-1945
NPI assigned
Dec 21, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Mrs. Carol D Hendrix
Title
A/R Officer
Phone
(304) 257-1155

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1036-8848 WV Primary

Addresses

Primary practice location

7 Mountain View St
Petersburg, WV 26847-1796

Mailing address

7 Mountain View St
Petersburg, WV 26847-1796
Phone (130) 425-7115

Other identifiers 3

IdentifierTypeStateIssuer
0005473000MedicaidWV
0005473002MedicaidWV
0005473001MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Potomac Highlands Guild6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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": "1261353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1205165347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 MOUNTAIN VIEW ST",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471796",
            "telephone_number": "130-425-7115",
            "fax_number": "304-257-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 MOUNTAIN VIEW ST",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "268471796",
            "telephone_number": "304-257-1555",
            "fax_number": "304-257-1945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC HIGHLANDS GUILD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-21",
        "last_updated": "2022-08-03",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "HENDRIX",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "A/R OFFICER",
        "authorized_official_telephone_number": "304-257-1155",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WV",
            "license": "1036-8848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005473000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005473002",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005473001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.