           |
 |
Certified Provider Details:
| PROVIDER NUMBER: | 490103 |
| AGENCY NAME: | Bureau for Behavioral Health Facilities |
| CONTACT NAME: | Roxanne K. Chaney |
| ADDRESS: | 350 Capitol Street, Room 350 |
| CITY: | Charleston |
| STATE: | WV |
| ZIP: | 25301 |
| PHONE: | (304) 558-0627 |
| WEB SITE: | www.wvdhhr.org/bhhf |
| EMAIL ADDRESS: | roxanne.k.chaney@wv.gov |
| BSW/MSW NAME: | Kimberly A. Walsh, MSW |
| DUE TO RECERTIFY DATE: | 7/1/2011 |
| COMMENTS: |