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Certified Provider Details:
| PROVIDER NUMBER: | 490042 |
| AGENCY NAME: | City Hospital Dept. of Education |
| CONTACT NAME: | Sue Nagley |
| ADDRESS: | P O Box 1418 |
| CITY: | Martinsburg |
| STATE: | WV |
| ZIP: | 254021418 |
| PHONE: | (304) 264-1287 ext. 1785 |
| WEB SITE: | |
| EMAIL ADDRESS: | snagley@cityhospital.org |
| BSW/MSW NAME: | Sara Burkhart BSW |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |