Provider Demographics
NPI:1306830559
Name:HOME NURSING SERVICE OF SOUTHWEST VIRGINIA, INC.
Entity Type:Organization
Organization Name:HOME NURSING SERVICE OF SOUTHWEST VIRGINIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:276-628-2666
Mailing Address - Street 1:611 CAMPUS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9700
Mailing Address - Country:US
Mailing Address - Phone:276-628-2666
Mailing Address - Fax:276-623-4276
Practice Address - Street 1:611 CAMPUS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9700
Practice Address - Country:US
Practice Address - Phone:276-628-2666
Practice Address - Fax:276-623-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0000364000402251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004973062Medicaid
VA006655OtherBCBS PROVIDER NUMBER
VA004973062Medicaid