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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