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General NPI Number Information
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NPI Number | 1811091804
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH'S HOSPICE
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 1 AMALIA DR
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City | BUCKHANNON
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State | WV
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Zip | 26201-2276
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Country | US
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Telephone | 304-473-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 1 AMALIA DR
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City | BUCKHANNON
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State | WV
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Zip | 26201-2276
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Country | US
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Telephone | 304-473-2000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | MRS. SUE E JOHNSON-PHILLIPPE
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Credential | FACHE
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Telephone | 304-473-2118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 23923495
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License Number State | WV
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