NPIMap

Organization Active NPI

Council of the Southern Mountains

  • Developmentally Disabled Services Day Training Agency
  • Keystone, WV
National Provider Identifier
1881716611
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
License
384 Issued in WV
Legal business name
COUNCIL OF THE SOUTHERN MOUNTAINS
Practice address
69 Main St.
Old Keystone Bank Building
Keystone, WV 24868-0085
Phone
(304) 862-3144
Fax
(304) 862-3071
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X 384 WV Primary

Addresses

Primary practice location

69 Main St.
Old Keystone Bank Building
Keystone, WV 24868-0085

Mailing address

PO Box 85
Northfork, WV 24868-0085
Phone (304) 862-3144

Other identifiers 1

IdentifierTypeStateIssuer
3810007636MedicaidWV

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": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1881716611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 85",
            "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.",
            "address_2": "OLD KEYSTONE BANK BUILDING",
            "city": "KEYSTONE",
            "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": "2007-04-04",
        "last_updated": "2008-08-13",
        "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.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "WV",
            "license": "384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810007636",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Keystone, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.