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Certified Provider Details:
| PROVIDER NUMBER: |
490088 |
| AGENCY NAME: |
River Park Hospital-Social Services |
| CONTACT NAME: |
Tamatha Miller |
| ADDRESS: |
1230 Sixth Avenue-PO Box 1875 |
| CITY: |
Huntington |
| STATE: |
WV |
| ZIP: |
257191875 |
| PHONE: |
(304) 526-9111 ext. 367 |
| WEB SITE: |
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| EMAIL ADDRESS: |
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| BSW/MSW NAME: |
David Nelson |
| DUE TO RECERTIFY DATE: |
7/1/2012 |
| COMMENTS: |
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