# PRIMARY CARE AT HOME OF WEST VIRGINIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Primary Care at Home of Charleston
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386163392
- **Authorized official:** DONALD D. STELLY (PRESIDENT)
- **Authorized official phone:** (337) 233-1307

## Contact information

- **Practice address:** 414 GREENWAY AVE STE 201, CHARLESTON, WV 25309-1475
- **Practice address phone:** (304) 356-1356
- **Practice address fax:** (304) 885-7475
- **Mailing address:** PO BOX 51266, LAFAYETTE, LA 70505-1266
- **Mailing address phone:** (337) 233-1307
- **Mailing address fax:** (337) 233-5764

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/12/2017
- **Last updated:** 09/12/2017