Provider Demographics
NPI:1144205170
Name:NORTHERN WV HOME HEALTH LLC
Entity Type:Organization
Organization Name:NORTHERN WV HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP &CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:APPLEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:304-258-6523
Mailing Address - Street 1:333 W CORK ST
Mailing Address - Street 2:SUITE 135
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3870
Mailing Address - Country:US
Mailing Address - Phone:540-536-5200
Mailing Address - Fax:540-536-5202
Practice Address - Street 1:109 WAR MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-1743
Practice Address - Country:US
Practice Address - Phone:304-788-1285
Practice Address - Fax:304-788-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001377002Medicaid
WV0001377002Medicaid