Provider Demographics
NPI:1811724024
Name:RILEY, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:RILEY
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MCGARY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-2152
Mailing Address - Country:US
Mailing Address - Phone:304-516-6977
Mailing Address - Fax:
Practice Address - Street 1:123 MCGARY AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-2152
Practice Address - Country:US
Practice Address - Phone:304-516-6977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide