           |
 |
Certified Provider Details:
| PROVIDER NUMBER: | 490075 |
| AGENCY NAME: | West Virginia Health Care Association |
| CONTACT NAME: | Sharon Mullins |
| ADDRESS: | 110 Association Drive |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25311 |
| PHONE: | (304) 346-4575 |
| WEB SITE: | www.wvhca.org |
| EMAIL ADDRESS: | smullins@wvhca.org |
| BSW/MSW NAME: | William Stone |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |