Healthcare Provider Details

I. General information

NPI: 1093828568
Provider Name (Legal Business Name): MINNIE HAMILTON HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/18/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 WV HWY 5 E SUITE 101
GLENVILLE WV
26351
US

IV. Provider business mailing address

186 HOSPITAL DRIVE
GRANTSVILLE WV
26147-7100
US

V. Phone/Fax

Practice location:
  • Phone: 304-462-7322
  • Fax:
Mailing address:
  • Phone: 304-354-9244
  • Fax: 304-354-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number150
License Number StateWV

VIII. Authorized Official

Name: MR. STEPHEN S. WHITED
Title or Position: CFO/COO
Credential:
Phone: 304-354-9244