Olympic Center Preston, Inc.

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

License

06GRR033 Issued in WV

Legal business name

OLYMPIC CENTER PRESTON, INC.

Practice address

RT. 7, Manown
Kingwood, WV 26537-0158

Phone

(304) 329-2400

Fax

(304) 329-2405

NPI assigned

May 16, 2007

Organization subpart

No

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

Authorized official

Name

Arlene Glover

Title

Executive Director

Phone

(304) 329-2400

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275740623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 158",
            "address_2": "RT. 7, MANOWN",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265370158",
            "telephone_number": "304-329-2400",
            "fax_number": "304-329-2405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RT. 7, MANOWN",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265370158",
            "telephone_number": "304-329-2400",
            "fax_number": "304-329-2405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC CENTER PRESTON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "ARLENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-329-2400"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "WV",
            "license": "06GRR033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810004372",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lillie Mae Nicholson
• Brady Nolan, DPT
• NP Care, LLC.
• Josh O'Dell, PTA
• Lelainia Ann O'Mara, RN
• Alexis Parker
• Debbie Darlene Parks
• Kevin A Passerby, MPT
• Suzanne Peddicord, RN, BSN
• Nicole Lorraine Peery

• Children's Substance Abuse Rehabilitation Facility in Kingwood, WV
• Providers in Kingwood, WV by specialty
• Children's Substance Abuse Rehabilitation Facility in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.