Healthcare Provider Details

I. General information

NPI: 1528654068
Provider Name (Legal Business Name): SUELINN ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 STAUNTON DR
WESTON WV
26452-5604
US

IV. Provider business mailing address

21 COLLEGE AVE
BUCKHANNON WV
26201-2650
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-9510
  • Fax: 304-269-2032
Mailing address:
  • Phone: 304-439-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: