Healthcare Provider Details

I. General information

NPI: 1205427739
Provider Name (Legal Business Name): JANICE DARLENE WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 W MAIN ST
GRAFTON WV
26354-1027
US

IV. Provider business mailing address

687 KILLARNEY DR APT E
MORGANTOWN WV
26505-2447
US

V. Phone/Fax

Practice location:
  • Phone: 681-209-3149
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: