Basic Information
| Provider Information | |||||||||
| NPI: | 1972784262 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INDEPENDENT HEALTHCARE PROVIDERS CORP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PSYCHSOLUTIONS4WV | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 LICK BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253126761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042080707 | ||||||||
| FaxNumber: | 8007589795 | ||||||||
| Practice Location | |||||||||
| Address1: | 661 LICK BRANCH RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253126761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042080707 | ||||||||
| FaxNumber: | 8007589795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2007 | ||||||||
| LastUpdateDate: | 02/14/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOSTIC | ||||||||
| AuthorizedOfficialFirstName: | LORETTA | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3042080707 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | DNP, APRN | ||||||||
| NPICertificationDate: | 02/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 251J00000X | N | Agencies | Nursing Care | 363LP0808X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.