Healthcare Provider Details

I. General information

NPI: 1972223378
Provider Name (Legal Business Name): ERIC VACOVSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S ELM ST
MOOREFIELD WV
26836-1257
US

IV. Provider business mailing address

134 S ELM ST
MOOREFIELD WV
26836-1257
US

V. Phone/Fax

Practice location:
  • Phone: 304-490-9246
  • Fax:
Mailing address:
  • Phone: 304-490-9246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: