Provider Demographics
NPI:1437763901
Name:JUSTICE, TORI CASSANDRA
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:CASSANDRA
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5095 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CYCLONE
Mailing Address - State:WV
Mailing Address - Zip Code:24827-9447
Mailing Address - Country:US
Mailing Address - Phone:304-673-7665
Mailing Address - Fax:
Practice Address - Street 1:5095 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CYCLONE
Practice Address - State:WV
Practice Address - Zip Code:24827-9447
Practice Address - Country:US
Practice Address - Phone:304-673-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant