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Certified Provider Details:
| PROVIDER NUMBER: |
490041 |
| AGENCY NAME: |
Florence Crittenton Home |
| CONTACT NAME: |
Beverly Petrelli |
| ADDRESS: |
2606 National Road |
| CITY: |
Wheeling |
| STATE: |
WV |
| ZIP: |
26003 |
| PHONE: |
(304) 242-7060 |
| WEB SITE: |
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| EMAIL ADDRESS: |
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| BSW/MSW NAME: |
Beverly Petrelli, ACSW, LCSW |
| DUE TO RECERTIFY DATE: |
7/1/2010 |
| COMMENTS: |
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