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General NPI Number Information
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NPI Number | 1194224485
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Entity Type | Organization
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Legal Business Name | AGE IN PLACE WEST VIRGINIA L.L.C
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 101 MEDICAL CT STE 202
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City | MARTINSBURG
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State | WV
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Zip | 25401-3854
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Country | US
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Telephone | 304-579-5853
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MEDICAL CT STE 202
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City | MARTINSBURG
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State | WV
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Zip | 25401-3854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF CARE-GIVING OFFICER
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Name | MINERVA DOUGAN
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Credential | BSN, RN, DNS-CT,
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Telephone | 304-579-5853
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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 |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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