Provider Demographics
NPI:1295536308
Name:RABIDEAU, JUSTIN CAMERON
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CAMERON
Last Name:RABIDEAU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 HALLECK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8622
Mailing Address - Country:US
Mailing Address - Phone:304-826-7494
Mailing Address - Fax:
Practice Address - Street 1:657 HALLECK RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8622
Practice Address - Country:US
Practice Address - Phone:304-826-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant