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Certified Provider Details:
| PROVIDER NUMBER: |
490087 |
| AGENCY NAME: |
William R. Sharpe, Jr. Hospital |
| CONTACT NAME: |
Elizabeth Young |
| ADDRESS: |
936 Sharpe Hospital Rd |
| CITY: |
Weston |
| STATE: |
WV |
| ZIP: |
26452 |
| PHONE: |
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| WEB SITE: |
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| EMAIL ADDRESS: |
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| BSW/MSW NAME: |
Elizabeth Young |
| DUE TO RECERTIFY DATE: |
7/1/2011 |
| COMMENTS: |
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