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Certified Provider Details:
| PROVIDER NUMBER: | 490030 |
| AGENCY NAME: | Children's Home Society of WV |
| CONTACT NAME: | Janet Craig |
| ADDRESS: | PO Box 2942 |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25330 |
| PHONE: | |
| WEB SITE: | www.childnswv.org |
| EMAIL ADDRESS: | jcraig@childhswv.org |
| BSW/MSW NAME: | Dennis Sutton |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |