Provider Demographics
NPI:1922009505
Name:WEIRTON MEDICAL CENTER HOME HEALTH INC
Entity Type:Organization
Organization Name:WEIRTON MEDICAL CENTER HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME CARE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-797-6495
Mailing Address - Street 1:601 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-797-6495
Mailing Address - Fax:304-797-6496
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-797-6495
Practice Address - Fax:304-797-6496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001352004Medicaid
WV0001352004Medicaid