Healthcare Provider Details

I. General information

NPI: 1174556641
Provider Name (Legal Business Name): KANAWHA HOSPICE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 KANAWHA BLVD W
CHARLESTON WV
25387-2536
US

IV. Provider business mailing address

1606 KANAWHA BLVD W
CHARLESTON WV
25387-2536
US

V. Phone/Fax

Practice location:
  • Phone: 304-768-8523
  • Fax: 304-768-6840
Mailing address:
  • Phone: 304-768-8523
  • Fax: 304-768-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0186990
License Number StateWV

VIII. Authorized Official

Name: MR. CHRISTOPHER RAWLINGS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-768-8523