Provider Demographics
NPI:1043201619
Name:KANAWHA-CHARLESTON HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KANAWHA-CHARLESTON HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GATELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-348-6821
Mailing Address - Street 1:108 LEE ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1506
Mailing Address - Country:US
Mailing Address - Phone:304-348-8152
Mailing Address - Fax:304-348-8072
Practice Address - Street 1:108 LEE ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1506
Practice Address - Country:US
Practice Address - Phone:304-348-8152
Practice Address - Fax:304-348-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021340001Medicaid
WV517806Medicare ID - Type Unspecified