Provider Demographics
NPI:1225600620
Name:CHURCH, RALPH A
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:CHURCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-8082
Mailing Address - Country:US
Mailing Address - Phone:304-647-9960
Mailing Address - Fax:
Practice Address - Street 1:321 CHURCH LN
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8082
Practice Address - Country:US
Practice Address - Phone:304-647-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker