Healthcare Provider Details

I. General information

NPI: 1023158102
Provider Name (Legal Business Name): EAST MOUNTAIN HEALTH ADVANTAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 E MAIN ST
ROMNEY WV
26757-1840
US

IV. Provider business mailing address

190 CAMPUS BLVD
WINCHESTER VA
22601-2872
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-5144
  • Fax:
Mailing address:
  • Phone: 540-536-8031
  • Fax: 540-540-8019

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: MR. CRAIG LEWIS
Title or Position: SECRETARY-TREASURER
Credential:
Phone: 540-536-8031