Provider Demographics
NPI:1184622722
Name:MARION COUNTY HEALTH DEPARTMENT HOME HEALTH SERVICE
Entity type:Organization
Organization Name:MARION COUNTY HEALTH DEPARTMENT HOME HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RS MPH
Authorized Official - Phone:304-366-5588
Mailing Address - Street 1:300 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2830
Mailing Address - Country:US
Mailing Address - Phone:304-366-5588
Mailing Address - Fax:304-366-9413
Practice Address - Street 1:300 2ND ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2830
Practice Address - Country:US
Practice Address - Phone:304-366-5588
Practice Address - Fax:304-366-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV022188251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0022865001Medicaid
WV=========OtherINSURANCE COMPANIES
WV0022865001Medicaid