Healthcare Provider Details

I. General information

NPI: 1730386558
Provider Name (Legal Business Name): YOUR CHOICE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 GRAY GABLES RD
CRAWLEY WV
24931
US

IV. Provider business mailing address

530 GRAY GABLES RD
CRAWLEY WV
24931
US

V. Phone/Fax

Practice location:
  • Phone: 304-392-6270
  • Fax: 304-392-6354
Mailing address:
  • Phone: 304-392-6270
  • Fax: 304-392-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALARIE PHILLIPS
Title or Position: MEMBER MANAGER
Credential:
Phone: 304-392-6270