1033699087 NPI number — E. A. HAWSE HEALTH CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033699087 NPI number — E. A. HAWSE HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E. A. HAWSE HEALTH CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033699087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKER
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26801-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-897-5915
Provider Business Mailing Address Fax Number:
304-897-6216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 VIKING DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PETERSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26847-1674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-257-1444
Provider Business Practice Location Address Fax Number:
304-897-6216
Provider Enumeration Date:
08/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
ADMINISTRATIVE ASSISTANT
Authorized Official Telephone Number:
304-897-5915

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1033347414 . This is a "GROVE STREET HEALTH CENTER NIP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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