1619915915 NPI number — PRIORITY ONE HOME CARE, LLC

Table of content: (NPI 1619915915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619915915 NPI number — PRIORITY ONE HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY ONE HOME CARE, LLC
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:
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:
1619915915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5611
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24739-5611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-425-4006
Provider Business Mailing Address Fax Number:
304-425-4019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2057 ATHENS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24739-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-425-4006
Provider Business Practice Location Address Fax Number:
304-425-4019
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VEST
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-425-4006

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010190401 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609435200 . This is a "FED. BLACK LUNG/WORK COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810002792 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001757231 . This is a "MOUNTAIN STATE BC/BS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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