Provider Demographics
NPI:1750757035
Name:PIECE OF MIND HOME HEALTH CARE AGENCY
Entity type:Organization
Organization Name:PIECE OF MIND HOME HEALTH CARE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS DEGREE
Authorized Official - Phone:304-257-6690
Mailing Address - Street 1:836 LUNICE CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-7528
Mailing Address - Country:US
Mailing Address - Phone:304-257-6690
Mailing Address - Fax:
Practice Address - Street 1:836 LUNICE CREEK HWY
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-7528
Practice Address - Country:US
Practice Address - Phone:304-257-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23198575261QA0600X, 253Z00000X, 251B00000X, 251J00000X, 385H00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care