Healthcare Provider Details

I. General information

NPI: 1659461804
Provider Name (Legal Business Name): MORGANTOWN HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3596 COLLINS FERRY RD SUITE 250
MORGANTOWN WV
26505-2374
US

IV. Provider business mailing address

3854 AMERICAN WAY STE A
BATON ROUGE LA
70816-4897
US

V. Phone/Fax

Practice location:
  • Phone: 304-285-2777
  • Fax: 304-285-1456
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number02861287
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number02861287
License Number StateWV

VIII. Authorized Official

Name: TRAVIS MIGLICCO
Title or Position: SVP TAX
Credential:
Phone: 225-299-3803