Organization
DODDRIDGE CO SENIOR CITIZEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARVIN E TRAVIS (DIRECTOR)
(304) 873-2061
Entity
Organization
Contact information
Practice address
403 W MAIN ST, WEST UNION, WV 26456-1127
(304) 873-2061
(304) 873-1769
Mailing address
403 W MAIN ST, WEST UNION, WV 26456-1127
(314) 873-2061
(304) 873-1769
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0030953002
—
WV
Enumeration date
04/18/2008
Last updated
11/07/2022
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