Healthcare Provider Details

I. General information

NPI: 1659475812
Provider Name (Legal Business Name): CITY OF SISTERSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 SOUTH WELLS STREET
SISTERSVILLE WV
26175
US

IV. Provider business mailing address

314 S WELLS ST
SISTERSVILLE WV
26175-1098
US

V. Phone/Fax

Practice location:
  • Phone: 304-652-2611
  • Fax: 304-652-1448
Mailing address:
  • Phone: 304-652-2611
  • Fax: 304-652-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number9
License Number StateWV

VIII. Authorized Official

Name: BRANDON W CHADOCK
Title or Position: AO
Credential:
Phone: 304-652-2611