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Certified Provider Details:
| PROVIDER NUMBER: | 490066 |
| AGENCY NAME: | Thomas Mem. Hosp. BHS |
| CONTACT NAME: | Linnet McCann |
| ADDRESS: | 4605 MacCorkle Ave, S.W. |
| CITY: | So. Charleston |
| STATE: | WV |
| ZIP: | 25309 |
| PHONE: | |
| WEB SITE: | www.thomaswv.org |
| EMAIL ADDRESS: | anna.laliotis@thomaswv.org |
| BSW/MSW NAME: | Anna Laliotis |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |