MEDICARE: VICTORIA ROSE CROSS

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	3747P1801X	Personal Care Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972288488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA ROSE CROSS

Provider Business Mailing Address
First Line	:	1996 RINES RIDGE RD
Second Line	:
City	:	PROCTOR
State	:	WV
Zip	:	26055-4046
Country	:	US
Telephone Number	:	304-650-0306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1996 RINES RIDGE RD
Second Line	:
City	:	PROCTOR
State	:	WV
Zip	:	26055-4046
Country	:	US
Telephone Number	:	304-650-0306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2023
Last Update Date	:	06/21/2023

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Directions to “ VICTORIA ROSE CROSS ” Practice Location

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