Provider Demographics
NPI:1073519922
Name:NICHOLAS-WEBSTER HOME HEALTH
Entity Type:Organization
Organization Name:NICHOLAS-WEBSTER HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-872-5328
Mailing Address - Street 1:1 STEVENS RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9704
Mailing Address - Country:US
Mailing Address - Phone:304-872-5328
Mailing Address - Fax:304-872-6128
Practice Address - Street 1:1 STEVENS RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9704
Practice Address - Country:US
Practice Address - Phone:304-872-5328
Practice Address - Fax:304-872-6128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0004879000Medicaid
WV517120Medicare ID - Type Unspecified