# MOUNTAINEER HOME HEALTH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629101910
- **Authorized official:** DR. LAWRENCE B KELLY M.D. (CEO)
- **Authorized official phone:** (304) 720-0205

## Contact information

- **Practice address:** 325 4TH AVE, SUITE 5, SOUTH CHARLESTON, WV 25303-1266
- **Practice address phone:** (304) 720-0205
- **Practice address fax:** (304) 720-0262
- **Mailing address:** 325 4TH AVE, SUITE 5, SOUTH CHARLESTON, WV 25303-1266
- **Mailing address phone:** (304) 720-0205
- **Mailing address fax:** (304) 720-0262

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 2007-011,481 | WV | — |
| 251E00000X | Home Health Agency | 90364 | WV | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 08/22/2020