Organization
MOUNTAINEER HOME HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE B KELLY M.D. (CEO)
(304) 720-0205
Entity
Organization
Contact information
Practice address
325 4TH AVE, SUITE 5, SOUTH CHARLESTON, WV 25303-1266
(304) 720-0205
(304) 720-0262
Mailing address
325 4TH AVE, SUITE 5, SOUTH CHARLESTON, WV 25303-1266
(304) 720-0205
(304) 720-0262
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
2007-011,481
WV
251E00000X
Home Health Agency
Primary
90364
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004241000
—
WV
Enumeration date
03/14/2007
Last updated
08/22/2020
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