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Certified Provider Details:
| PROVIDER NUMBER: | 490076 |
| AGENCY NAME: | Children's Home of Wheeling, Inc. |
| CONTACT NAME: | Judith Dietrich |
| ADDRESS: | 1 Orchard Road |
| CITY: | Wheeling |
| STATE: | WV |
| ZIP: | 26003 |
| PHONE: | (304) 233-2367 |
| WEB SITE: | www.childrenshomeofwheeling.com |
| EMAIL ADDRESS: | |
| BSW/MSW NAME: | Lisa Witzberger |
| DUE TO RECERTIFY DATE: | 7/1/2010 |
| COMMENTS: |