Healthcare Provider Details

I. General information

NPI: 1295793669
Provider Name (Legal Business Name): DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 MAIN STREET
CHAPMANVILLE WV
25508
US

IV. Provider business mailing address

557 MAIN STREET PO BOX 4304
CHAPMANVILLE WV
25508
US

V. Phone/Fax

Practice location:
  • Phone: 304-855-4764
  • Fax:
Mailing address:
  • Phone: 304-855-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number02940195
License Number StateWV

VIII. Authorized Official

Name: MRS. SUSAN P GORE
Title or Position: ACCOUNTING CLERK
Credential:
Phone: 304-855-4764