Provider Demographics
NPI:1780645127
Name:HOSPITAL DEVELOPMENT CO. DBA ROANE GENERAL HOSPITAL
Entity Type:Organization
Organization Name:HOSPITAL DEVELOPMENT CO. DBA ROANE GENERAL HOSPITAL
Other - Org Name:ROANE GENERAL HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-927-6200
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1050
Mailing Address - Country:US
Mailing Address - Phone:304-927-6514
Mailing Address - Fax:304-927-6807
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1050
Practice Address - Country:US
Practice Address - Phone:304-927-6514
Practice Address - Fax:304-927-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV74251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0123058005Medicaid
WV517123Medicare Oscar/Certification