MEDICARE: NICHOLAS-WEBSTER HOME HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	NA	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073519922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS-WEBSTER HOME HEALTH

Provider Business Mailing Address
First Line	:	1 STEVENS RD
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-9704
Country	:	US
Telephone Number	:	304-872-5328
Fax Number	:	304-872-6128

Provider Business Practice Location Address
First Line	:	1 STEVENS RD
Second Line	:
City	:	SUMMERSVILLE
State	:	WV
Zip	:	26651-9704
Country	:	US
Telephone Number	:	304-872-5328
Fax Number	:	304-872-6128

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. DIANA LYNN SEARS
Credential	:
Telephone Number	:	304-872-5328

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/22/2020

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