NPIMap

Organization Active NPI

Council of the Southern Mountains

  • Case Management Agency
  • Northfork, WV
National Provider Identifier
1366625915
Registry record updated Dec 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
384 Issued in WV
Legal business name
COUNCIL OF THE SOUTHERN MOUNTAINS
Practice address
69 Main St.
Northfork, WV 24868-0085
Phone
(304) 862-3144
Fax
(304) 862-3071
NPI assigned
Dec 6, 2007
Last updated
Dec 6, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2007

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

Authorized official

Name
Mr. Randal Johnson
Title
Executive Director
Phone
(304) 862-3144

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 384 WV Primary

Addresses

Primary practice location

69 Main St.
Northfork, WV 24868-0085

Mailing address

PO Box 85
69 Main St.
Northfork, WV 24868-0085
Phone (304) 862-3144

Other identifiers 2

IdentifierTypeStateIssuer
3810009682MedicaidWV
3810009683MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Council of the Southern Mountains7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1366625915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 85",
            "address_2": "69 MAIN ST.",
            "city": "NORTHFORK",
            "state": "WV",
            "postal_code": "248680085",
            "telephone_number": "304-862-3144",
            "fax_number": "304-862-3071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 MAIN ST.",
            "city": "NORTHFORK",
            "state": "WV",
            "postal_code": "248680085",
            "telephone_number": "304-862-3144",
            "fax_number": "304-862-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNCIL OF THE SOUTHERN MOUNTAINS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RANDAL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-862-3144",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WV",
            "license": "384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009682",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009683",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northfork, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; 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.