Healthcare Provider Details

I. General information

NPI: 1003724931
Provider Name (Legal Business Name): JAIDEN THOMAS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CENTER ST
ELK GARDEN WV
26717-9413
US

IV. Provider business mailing address

PO BOX 171
ELK GARDEN WV
26717-0171
US

V. Phone/Fax

Practice location:
  • Phone: 304-813-6136
  • Fax:
Mailing address:
  • Phone: 304-813-6136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: