Provider Demographics
NPI:1437455730
Name:DEFELICECARE INC
Entity Type:Organization
Organization Name:DEFELICECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:DEFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-232-4210
Mailing Address - Street 1:76 SIXTEENTH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3660
Mailing Address - Country:US
Mailing Address - Phone:304-232-4210
Mailing Address - Fax:304-232-4213
Practice Address - Street 1:6118 MID ATLANTIC DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4294
Practice Address - Country:US
Practice Address - Phone:304-594-1222
Practice Address - Fax:304-594-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1043-4828332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0962250005Medicare NSC