Healthcare Provider Details

I. General information

NPI: 1912704388
Provider Name (Legal Business Name): LUDDIE SHAWN FARLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 LAYLAND HEIGHTS RD BOX 2
LAYLAND WV
25864-2586
US

IV. Provider business mailing address

PO BOX 2
LAYLAND WV
25864-0002
US

V. Phone/Fax

Practice location:
  • Phone: 681-222-8837
  • Fax:
Mailing address:
  • Phone: 681-222-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: