Organization
IN HOME CARE LLC
Active
Other names
Life Guard Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY GALE CLEVENGER (OWNER)
(304) 659-3535
Entity
Organization
Contact information
Practice address
108 PULLMAN DR, PENNSBORO, WV 26415
(304) 659-3535
Mailing address
PO BOX 386, 108 PULLMAN DRIVE, PENNSBORO, WV 26415
(304) 659-3535
(304) 659-3118
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810002357
—
WV
Enumeration date
07/27/2006
Last updated
08/22/2020
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