Provider Demographics
NPI:1124225859
Name:WETZEL COUNTY HOMECARE
Entity Type:Organization
Organization Name:WETZEL COUNTY HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-455-5515
Mailing Address - Street 1:299 N STATE ROUTE 2
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-2243
Mailing Address - Country:US
Mailing Address - Phone:304-455-5515
Mailing Address - Fax:304-455-4796
Practice Address - Street 1:299 N ST RT 2
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155
Practice Address - Country:US
Practice Address - Phone:304-455-5515
Practice Address - Fax:304-455-4796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001221006Medicaid
WV517086Medicare ID - Type Unspecified