Provider Demographics
NPI:1598884785
Name:INDIVIDUAL HOME CARE, INC.
Entity Type:Organization
Organization Name:INDIVIDUAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-872-2189
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-0455
Mailing Address - Country:US
Mailing Address - Phone:304-872-2189
Mailing Address - Fax:304-872-2189
Practice Address - Street 1:ROUTE 19, 77 PUDDY RUN ROAD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-0455
Practice Address - Country:US
Practice Address - Phone:304-872-2189
Practice Address - Fax:304-872-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV032828251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0031070000Medicaid