Healthcare Provider Details

I. General information

NPI: 1740709146
Provider Name (Legal Business Name): STONERISE RELIABLE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 GLENWOOD PARK ROAD
PRINCETON WV
24739
US

IV. Provider business mailing address

700 CHAPPELL RD
CHARLESTON WV
25304-2704
US

V. Phone/Fax

Practice location:
  • Phone: 304-323-2300
  • Fax: 304-323-2307
Mailing address:
  • Phone: 304-343-1950
  • Fax: 304-343-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES STOLTZ
Title or Position: TREASURER
Credential:
Phone: 513-489-7100