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General NPI Number Information
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NPI Number | 1184622722
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Entity Type | Organization
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Legal Business Name | MARION COUNTY HEALTH DEPARTMENT HOME HEALTH SERVICE
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 2ND ST
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City | FAIRMONT
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State | WV
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Zip | 26554-2830
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Country | US
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Telephone | 304-366-5588
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Fax | 304-366-9413
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Provider Business Mailing Address
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Address Line | 300 2ND ST
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City | FAIRMONT
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State | WV
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Zip | 26554-2830
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Country | US
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Telephone | 304-366-5588
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Fax | 304-366-9413
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. LLOYD R WHITE
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Credential | RS MPH
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Telephone | 304-366-5588
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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 | 022188
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License Number State | WV
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