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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Christina Elaine Jack | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Christina Elaine | [sources] | |||
| Last name | Jack | [sources] | |||
| NPI | 1811565542 | [sources] | |||
| Address | 5341 Clear Fork Road, Dorothy, WV 25060 | [sources] | |||
| Last change | Last processed | First seen | |||
Medicaid providers sanctioned in West Virginia's Medicaid program.
United States · MMIS
us-medwv-a3ae2d5b03893ed33253c10b0752e959a8ff4a3d · us-npi-1811565542For experts: raw data explorer
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States | Medicaid Management Information System | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| 5341 Clear Fork Road, Dorothy, WV 25060 | United States | |