Organization
GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
Active
Organization
GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
Active
Other names
Grant Memorial Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA L PROFFITT (PRESIDENT)
(337) 233-1307
Entity
Organization
Contact information
Practice address
100 HOSPITAL DRIVE, SUITE 2, PETERSBURG, WV 26847-9409
(304) 257-2005
(304) 257-2093
Mailing address
PO BOX 51266, LAFAYETTE, LA 70505-1266
(337) 233-1307
(337) 233-5764
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
16
WV
315D00000X
Inpatient Hospice
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810013853
—
WV
01
—
3810013879
MEDICAID - NURSING HOME
WV
Enumeration date
05/27/2008
Last updated
09/06/2024
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