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General NPI Number Information
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NPI Number | 1083617989
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Entity Type | Organization
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Legal Business Name | STONEWALL JACKSON MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 456 SUITE B MARKET PLACE MALL
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City | WESTON
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State | WV
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Zip | 26452-6938
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Country | US
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Telephone | 304-269-4556
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Fax | 304-269-4559
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Provider Business Mailing Address
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Address Line | 456 SUITE B MARKET PLACE MALL
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City | WESTON
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State | WV
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Zip | 26452-6938
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Country | US
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Telephone | 304-269-4556
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Fax | 304-269-4559
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Authorized Official
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Title or Position | DIRECTOR OF EXTERNAL OPERATIONS
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Name | MRS. M. JANE EISENBEIS
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Credential | RN
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Telephone | 304-269-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | WV
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