Healthcare Provider Details

I. General information

NPI: 1811091804
Provider Name (Legal Business Name): ST. JOSEPH'S HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMALIA DR
BUCKHANNON WV
26201-2276
US

IV. Provider business mailing address

1 AMALIA DR
BUCKHANNON WV
26201-2276
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-2000
  • Fax:
Mailing address:
  • Phone: 304-473-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number23923495
License Number StateWV

VIII. Authorized Official

Name: MRS. SUE E JOHNSON-PHILLIPPE
Title or Position: PRESIDENT & CHIEF EXECUTIVE OFFICER
Credential: FACHE
Phone: 304-473-2118