Healthcare Provider Details

I. General information

NPI: 1750757035
Provider Name (Legal Business Name): PIECE OF MIND HOME HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 LUNICE CREEK HWY
PETERSBURG WV
26847-7528
US

IV. Provider business mailing address

836 LUNICE CREEK HWY
PETERSBURG WV
26847-7528
US

V. Phone/Fax

Practice location:
  • Phone: 304-257-6690
  • Fax:
Mailing address:
  • Phone: 304-257-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number23198575
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number23198575
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number23198575
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number23198575
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number23198575
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BRENDA LYNN DAVIS
Title or Position: OWNER
Credential: BACHELORS DEGREE
Phone: 304-257-6690