Healthcare Provider Details

I. General information

NPI: 1598884785
Provider Name (Legal Business Name): INDIVIDUAL HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 19, 77 PUDDY RUN ROAD
SUMMERSVILLE WV
26651-0455
US

IV. Provider business mailing address

PO BOX 455
SUMMERSVILLE WV
26651-0455
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-2189
  • Fax: 304-872-2189
Mailing address:
  • Phone: 304-872-2189
  • Fax: 304-872-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number032828
License Number StateWV

VIII. Authorized Official

Name: MARK E. ROMANO
Title or Position: PRESIDENT
Credential:
Phone: 304-872-2189