Provider Demographics
NPI:1619915915
Name:PRIORITY ONE HOME CARE, LLC
Entity Type:Organization
Organization Name:PRIORITY ONE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:VEST
Authorized Official - Suffix:II
Authorized Official - Credentials:RRT
Authorized Official - Phone:304-425-4006
Mailing Address - Street 1:PO BOX 5611
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-5611
Mailing Address - Country:US
Mailing Address - Phone:304-425-4006
Mailing Address - Fax:304-425-4019
Practice Address - Street 1:2057 ATHENS ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24739-6258
Practice Address - Country:US
Practice Address - Phone:304-425-4006
Practice Address - Fax:304-425-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
WV332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010190401Medicaid
WV609435200OtherFED. BLACK LUNG/WORK COMP
WV3810002792Medicaid
WV001757231OtherMOUNTAIN STATE BC/BS
WV609435200OtherFED. BLACK LUNG/WORK COMP