MEDICARE: MY FATHER'S HOUSE INC., PRENATAL & RESOURCE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1083900120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY FATHER'S HOUSE INC., PRENATAL & RESOURCE CENTER

Provider Business Mailing Address
First Line	:	101 MEDICAL COURT, SUITE 212
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401
Country	:	US
Telephone Number	:	304-885-0017
Fax Number	:	304-932-0831

Provider Business Practice Location Address
First Line	:	101 MEDICAL CT STE 212
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-3854
Country	:	US
Telephone Number	:	304-885-0017
Fax Number	:	304-932-0831

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. FELICIA SHANTELL STEVENSON
Credential	:
Telephone Number	:	304-240-6339

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	06/28/2011

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