Provider Demographics
NPI:1902801426
Name:MAINSTREAM SERVICES, INCORPORATED
Entity Type:Organization
Organization Name:MAINSTREAM SERVICES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-522-1945
Mailing Address - Street 1:4757C ROUTE 152
Mailing Address - Street 2:
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535-9703
Mailing Address - Country:US
Mailing Address - Phone:304-522-1945
Mailing Address - Fax:304-522-1946
Practice Address - Street 1:4757C ROUTE 152
Practice Address - Street 2:
Practice Address - City:LAVALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535-9703
Practice Address - Country:US
Practice Address - Phone:304-522-1945
Practice Address - Fax:304-522-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV278251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810001125Medicaid