Organization
CUSTOM HOME ELEVATOR OF W V
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES A BLAIR (OWNER)
(304) 552-6578
Entity
Organization
Contact information
Practice address
100 PIONEER STREET, EAST BANK, WV 25067-0483
(304) 552-6578
(304) 595-1234
Mailing address
PO BOX 483, EAST BANK, WV 25067-0483
(304) 552-6578
(304) 595-1234
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
WV
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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