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General NPI Number Information
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NPI Number | 1053579102
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Entity Type | Organization
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Legal Business Name | GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DRIVE SUITE 2
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City | PETERSBURG
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State | WV
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Zip | 26847-9409
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Country | US
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Telephone | 304-257-2005
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Fax | 304-257-2093
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSHUA L PROFFITT
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Credential |
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Telephone | 337-233-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 16
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License Number State | WV
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