Healthcare Provider Details

I. General information

NPI: 1255006086
Provider Name (Legal Business Name): RACHAEL PAIGE GIFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MOUNTAIN PARK DR
FAIRMONT WV
26554-8992
US

IV. Provider business mailing address

10 MOUNTAIN PARK DR
FAIRMONT WV
26554-8992
US

V. Phone/Fax

Practice location:
  • Phone: 304-816-3687
  • Fax: 304-816-3737
Mailing address:
  • Phone: 304-816-3687
  • Fax: 304-816-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: