Healthcare Provider Details

I. General information

NPI: 1225803455
Provider Name (Legal Business Name): TIMOTHY EDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2197 NATIONAL RD
WHEELING WV
26003-5202
US

IV. Provider business mailing address

2197 NATIONAL RD
WHEELING WV
26003-5202
US

V. Phone/Fax

Practice location:
  • Phone: 304-233-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: