Healthcare Provider Details

I. General information

NPI: 1083617989
Provider Name (Legal Business Name): STONEWALL JACKSON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 SUITE B MARKET PLACE MALL
WESTON WV
26452-6938
US

IV. Provider business mailing address

456 SUITE B MARKET PLACE MALL
WESTON WV
26452-6938
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-4556
  • Fax: 304-269-4559
Mailing address:
  • Phone: 304-269-4556
  • Fax: 304-269-4559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. M. JANE EISENBEIS
Title or Position: DIRECTOR OF EXTERNAL OPERATIONS
Credential: RN
Phone: 304-269-4556