Healthcare Provider Details

I. General information

NPI: 1174899496
Provider Name (Legal Business Name): MORGANTOWN AREA PRIVATE DUTY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 FAIRMONT RD STE 201
MORGANTOWN WV
26501-3892
US

IV. Provider business mailing address

829 FAIRMONT RD STE 201
MORGANTOWN WV
26501-3892
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-6600
  • Fax: 304-296-6800
Mailing address:
  • Phone: 304-296-6600
  • Fax: 304-296-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JEANNINE POWELL
Title or Position: MANAGER
Credential:
Phone: 304-296-6600