Provider Demographics
NPI:1225207525
Name:ALL CARE HOME AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:ALL CARE HOME AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGEMENT SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOPEZ
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-294-8800
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:ITMANN
Mailing Address - State:WV
Mailing Address - Zip Code:24847-0130
Mailing Address - Country:US
Mailing Address - Phone:304-294-8800
Mailing Address - Fax:304-294-8805
Practice Address - Street 1:RT. 10 OLD ITMANN GRADE SCHOOL
Practice Address - Street 2:
Practice Address - City:ITMANN
Practice Address - State:WV
Practice Address - Zip Code:24847
Practice Address - Country:US
Practice Address - Phone:304-294-8800
Practice Address - Fax:304-294-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030823001Medicaid