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Certified Provider Details:
| PROVIDER NUMBER: | 490073 |
| AGENCY NAME: | N.C. WV Community Action Head Start |
| CONTACT NAME: | Kristi Hixenbaugh |
| ADDRESS: | 1304 Goose Run Road |
| CITY: | Fairmont |
| STATE: | WV |
| ZIP: | 26554 |
| PHONE: | (304) 363-2170 ext. 125 |
| WEB SITE: | www.ncwvcaa.org |
| EMAIL ADDRESS: | khixenbaugh@ncwvcaa.org |
| BSW/MSW NAME: | Ruth Ann Ponzurick |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |