Healthcare Provider Details

I. General information

NPI: 1659600310
Provider Name (Legal Business Name): PRESTON MEMORIAL HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 MORGANTOWN ST
KINGWOOD WV
26537-1095
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-3565
  • Fax: 304-329-4709
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-443-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSHUA L PROFFITT
Title or Position: PRESIDENT
Credential:
Phone: 337-233-1307