Provider Demographics
NPI:1992846307
Name:DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA, INC.
Entity Type:Organization
Organization Name:DIGNITY HOSPICE OF SOUTHERN WEST VIRGINIA, INC.
Other - Org Name:DIGNITY HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-855-4764
Mailing Address - Street 1:P.O. BOX 4304
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508
Mailing Address - Country:US
Mailing Address - Phone:304-855-4764
Mailing Address - Fax:304-831-6001
Practice Address - Street 1:557 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-4764
Practice Address - Fax:304-831-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV041729251E00000X
WV2940195251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV517134Medicare Oscar/Certification
517134Medicare PIN