Organization
KANAWHA MEDICAL SUPPLY
Active
Parent organization
KANAWHA MEDICAL SUPPLY
Other names
Kanawha Personal Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
KANAWHA MEDICAL SUPPLY
Authorized official
MR. WILLIAM CARL PERGERSONA (DIRECT OWNER/CFO)
(804) 330-5743
Entity
Organization
Contact information
Practice address
7009 FOREST HILL AVE, RICHMOND, VA 23225-1607
(804) 330-5743
(804) 330-7149
Mailing address
7009 FOREST HILL AVE, RICHMOND, VA 23225-1607
(804) 330-5743
(804) 330-7149
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0087009400
—
VA
05
—
0087720295
—
VA
05
—
0102164867
—
VA
05
—
0102181440
—
VA
05
—
0102181952
—
VA
Enumeration date
07/24/2015
Last updated
07/24/2015
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