Healthcare Provider Details

I. General information

NPI: 1144873605
Provider Name (Legal Business Name): CASSIE L JUSTICE CMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

103 2ND AVE
CHESAPEAKE OH
45619-1134
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-8700
  • Fax: 304-696-8701
Mailing address:
  • Phone: 740-451-1551
  • Fax: 740-451-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number23-965
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: