Healthcare Provider Details

I. General information

NPI: 1497746218
Provider Name (Legal Business Name): HOME IV CARE AND NUTRITIONAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HILL CARTER PKWY
ASHLAND VA
23005-2324
US

IV. Provider business mailing address

340 HILL CARTER PKWY
ASHLAND VA
23005-2324
US

V. Phone/Fax

Practice location:
  • Phone: 804-752-3415
  • Fax: 804-752-3418
Mailing address:
  • Phone: 804-752-3415
  • Fax: 804-752-3418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201003066
License Number StateVA

VIII. Authorized Official

Name: GARY S MORSE
Title or Position: VICE PRESIDENT REIMBURSEMENT
Credential:
Phone: 301-353-0300