Provider Demographics
NPI:1043759368
Name:ESSENTIAL NEEDS HOMECARE
Entity Type:Organization
Organization Name:ESSENTIAL NEEDS HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-816-3687
Mailing Address - Street 1:2019 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9295
Mailing Address - Country:US
Mailing Address - Phone:304-816-3687
Mailing Address - Fax:
Practice Address - Street 1:16 MOUNTAIN PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8992
Practice Address - Country:US
Practice Address - Phone:304-816-3687
Practice Address - Fax:304-816-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22893837251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821424755Medicaid