Provider Demographics
NPI:1225372717
Name:PRIORITY ONE HOME CARE II
Entity Type:Organization
Organization Name:PRIORITY ONE HOME CARE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:304-445-4960
Mailing Address - Street 1:PO BOX 739
Mailing Address - Street 2:103 RAILROAD AVE
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-0739
Mailing Address - Country:US
Mailing Address - Phone:304-445-4960
Mailing Address - Fax:304-445-4962
Practice Address - Street 1:103 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ALDERSON
Practice Address - State:WV
Practice Address - Zip Code:24910
Practice Address - Country:US
Practice Address - Phone:304-445-4960
Practice Address - Fax:304-445-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVLRTR0042332B00000X
332BN1400X, 332BP3500X, 335E00000X
WVLRTR0442332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
6921750001Medicare NSC