Healthcare Provider Details

I. General information

NPI: 1871544213
Provider Name (Legal Business Name): NORTHERN WV HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25072 NORTHWESTERN PIKE
ROMNEY WV
26757-0288
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 320
WINCHESTER VA
22601-2889
US

V. Phone/Fax

Practice location:
  • Phone: 888-797-3787
  • Fax: 540-536-3284
Mailing address:
  • Phone: 540-536-5100
  • Fax: 540-536-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number02
License Number StateWV

VIII. Authorized Official

Name: JILL CHAMBERS
Title or Position: MANAGER INSURANCE CREDENTIALING
Credential:
Phone: 540-536-0231