MEDICARE: PEYATTE INC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1417412354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEYATTE INC

Provider Business Mailing Address
First Line	:	5324 MACCORKLE AVE SE STE 1
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2200
Country	:	US
Telephone Number	:	304-693-2500
Fax Number	:	304-693-2501

Provider Business Practice Location Address
First Line	:	5324 MACCORKLE AVE SE STE 1
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-2200
Country	:	US
Telephone Number	:	304-693-2500
Fax Number	:	304-693-2501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KARI PEYATTE
Credential	:
Telephone Number	:	304-693-2500

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	02/05/2019

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Directions to “PEYATTE INC ” Practice Location

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