Healthcare Provider Details

I. General information

NPI: 1841107372
Provider Name (Legal Business Name): ALLISON SHAHAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 CHUB RUN RD
MOUNT CLARE WV
26408-7132
US

IV. Provider business mailing address

1881 CHUB RUN RD
MOUNT CLARE WV
26408-7132
US

V. Phone/Fax

Practice location:
  • Phone: 304-695-4087
  • Fax:
Mailing address:
  • Phone: 304-695-4087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: