Provider Demographics
NPI:1023380789
Name:VISITING HOMEMAKER SERVICE OF MONONGALIA COUNTY, INC.
Entity Type:Organization
Organization Name:VISITING HOMEMAKER SERVICE OF MONONGALIA COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-599-7743
Mailing Address - Street 1:382 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3193
Mailing Address - Country:US
Mailing Address - Phone:304-599-7743
Mailing Address - Fax:304-599-5922
Practice Address - Street 1:382 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3193
Practice Address - Country:US
Practice Address - Phone:304-599-7743
Practice Address - Fax:304-599-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1035-4182251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030862000Medicaid