MEDICARE: MOUNTAIN STATE HOME HEALTH CARE, 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	251E00000X	Home Health Agency		WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5210007000	OTHER	WV	RIGHT FROM THE START
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770682700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN STATE HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	254 GEORGE ST
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-2641
Country	:	US
Telephone Number	:	304-256-8201
Fax Number	:	304-256-8204

Provider Business Practice Location Address
First Line	:	254 GEORGE ST
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-2641
Country	:	US
Telephone Number	:	304-256-8201
Fax Number	:	304-256-8204

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. VALARIE L PHILLIPS
Credential	:	R.N.
Telephone Number	:	304-256-8201

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/21/2022

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