Provider Demographics
NPI:1518527332
Name:KANAWHA HOME HEALTH CASE MANAGEMENT
Entity type:Organization
Organization Name:KANAWHA HOME HEALTH CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:681-265-3931
Mailing Address - Street 1:3324 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-4656
Mailing Address - Country:US
Mailing Address - Phone:681-265-3931
Mailing Address - Fax:681-265-5123
Practice Address - Street 1:20 BROOKS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2903
Practice Address - Country:US
Practice Address - Phone:681-265-3931
Practice Address - Fax:681-265-5123
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANAWHA HOME HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-14
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0030875000Medicaid