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NPI Code Detail

MEDICARE: PRINCETON COMMUNITY HOMECARE, LLC

MEDICARE: PRINCETON COMMUNITY HOMECARE, LLC
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1861527715
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRINCETON COMMUNITY HOMECARE, LLC
Provider Business Mailing Address
First Line : PO BOX 51266
Second Line :
City : LAFAYETTE
State : LA
Zip : 70505-1266
Country : US
Telephone Number : 337-233-1307
Fax Number : 337-233-5764
Provider Business Practice Location Address
First Line : 738 MERCER ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3114
Country : US
Telephone Number : 304-323-3069
Fax Number : 304-324-7946
Authorized Official
Title or Position : PRESIDENT
Name : JOSHUA L PROFFITT
Credential :
Telephone Number : 337-233-1307
Provider Enumeration Date : 02/22/2007
Last Update Date : 09/06/2024

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Directions to “PRINCETON COMMUNITY HOMECARE, LLC ” Practice Location

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