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NPI Code Detail

MEDICARE: JUSTICE MARIE MONGOLD

MEDICARE: JUSTICE MARIE MONGOLD
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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1396696324
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTICE MARIE MONGOLD
Provider Business Mailing Address
First Line : 31 ELMWOOD BLVD
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-9201
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1408 HARRISON AVE
Second Line :
City : ELKINS
State : WV
Zip : 26241-3325
Country : US
Telephone Number : 304-636-4390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2026
Last Update Date : 02/05/2026

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Directions to “ JUSTICE MARIE MONGOLD ” Practice Location

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