MEDICARE: VOCA CORPORATION OF WEST VIRGINIA, 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	315P00000X	Intellectual Disabilities Intermediate Care Facility

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	:	1982769550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOCA CORPORATION OF WEST VIRGINIA, INC.

Provider Business Mailing Address
First Line	:	805 N WHITTINGTON PKWY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-7101
Country	:	US
Telephone Number	:	502-394-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1519 8TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-2923
Country	:	US
Telephone Number	:	304-523-0177
Fax Number	:	304-523-0178

Authorized Official
Title or Position	:	PROVIDER ENROLLMENT
Name	:	MR. TIMOTHY WHOBREY
Credential	:
Telephone Number	:	502-630-7249

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	11/10/2021

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