Healthcare Provider Details

I. General information

NPI: 1497364624
Provider Name (Legal Business Name): SAMANTHA FARRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 FARRA LN
SANDYVILLE WV
25275-6523
US

IV. Provider business mailing address

428 FARRA LN
SANDYVILLE WV
25275-6523
US

V. Phone/Fax

Practice location:
  • Phone: 304-273-2846
  • Fax:
Mailing address:
  • Phone: 304-273-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: