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General NPI Number Information
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NPI Number | 1548878119
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Entity Type | Individual
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Provider Name | CODI ROSS
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Gender | Male
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 501 WILSON LN STE 3
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City | ELKINS
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State | WV
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Zip | 26241-5216
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Country | US
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Telephone | 304-636-9396
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Fax | 304-636-0719
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Provider Business Mailing Address
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Address Line | 18 CENTRAL ST
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City | ELKINS
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State | WV
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Zip | 26241-3109
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Country | US
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Telephone | 304-642-6366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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