Basic Information
| Provider Information | |||||||||
| NPI: | 1699280800 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KANAWHA HOSPICE CARE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PALLATIVE CARE CORPORATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1606 KANAWHA BLVD W | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253872536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047688523 | ||||||||
| FaxNumber: | 3049411902 | ||||||||
| Practice Location | |||||||||
| Address1: | 1606 KANAWHA BLVD W | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253872536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047688523 | ||||||||
| FaxNumber: | 3049411902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2017 | ||||||||
| LastUpdateDate: | 12/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 3047688523 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.