Organization
BROADDUS HOSPITAL ASSOCIATION, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANA L. GOULD (CEO)
(304) 457-8155
Entity
Organization
Contact information
Practice address
#1 HEALTHCARE DRIVE, MANSFIELD HILL, PHILIPPI, WV 26416
(304) 457-1760
(304) 457-1516
Mailing address
#1 HEALTHCARE DRIVE, P.O. BOX 930, PHILIPPI, WV 26416
(304) 457-1760
(304) 457-1516
Taxonomy
Speciality
Code
Description
License number
State
282NC0060X
Critical Access Hospital
Primary
96
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002167000
—
WV
01
—
CE1018
MEDICARE RAILROAD
WV
Enumeration date
12/20/2005
Last updated
07/09/2019
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