Healthcare Provider Details

I. General information

NPI: 1114539558
Provider Name (Legal Business Name): ATHENA KAROL PAIGE PLIVELICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 YORK RD
BUCKHANNON WV
26201-6986
US

IV. Provider business mailing address

501 WILSON LN
ELKINS WV
26241-5216
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-9326
  • Fax:
Mailing address:
  • Phone: 304-636-9326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: