1871686717 NPI number — HOSPICE OF SOUTHERN WEST VIRGINIA, INC

Table of content: (NPI 1871686717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871686717 NPI number — HOSPICE OF SOUTHERN WEST VIRGINIA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF SOUTHERN WEST VIRGINIA, 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:
PALLIATIVE CARE OF SOUTHERN WEST VIRGINIA
Provider Other Organization Name Type Code:
3
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:
1871686717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BECKLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25802-1472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-255-6404
Provider Business Mailing Address Fax Number:
304-255-6494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
456 CRANBERRY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-8560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-255-6404
Provider Business Practice Location Address Fax Number:
304-255-6494
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
JANETT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
304-255-6404

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  6 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0005593000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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