Healthcare Provider Details

I. General information

NPI: 1689109431
Provider Name (Legal Business Name): MCCOY R.N.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 POLK ST
DELBARTON WV
25670-1107
US

IV. Provider business mailing address

57 POLK ST
DELBARTON WV
25670-1107
US

V. Phone/Fax

Practice location:
  • Phone: 304-475-2192
  • Fax: 304-475-3817
Mailing address:
  • Phone: 304-475-2192
  • Fax: 304-475-3817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number89109
License Number StateWV

VIII. Authorized Official

Name: RITA DAWN MCCOY
Title or Position: OWNER
Credential: RN
Phone: 304-475-2192