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General NPI Number Information
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NPI Number | 1770682700
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATE HOME HEALTH CARE, INC.
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 254 GEORGE ST
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City | BECKLEY
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State | WV
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Zip | 25801-2641
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Country | US
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Telephone | 304-256-8201
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Fax | 304-256-8204
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Provider Business Mailing Address
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Address Line | 254 GEORGE ST
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City | BECKLEY
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State | WV
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Zip | 25801-2641
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Country | US
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Telephone | 304-256-8201
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Fax | 304-256-8204
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VALARIE L PHILLIPS
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Credential | R.N.
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Telephone | 304-256-8201
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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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