Provider Demographics
NPI:1194722595
Name:HOSPICE CARE CORPORATION
Entity type:Organization
Organization Name:HOSPICE CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-864-0884
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:ARTHURDALE
Mailing Address - State:WV
Mailing Address - Zip Code:26520-0760
Mailing Address - Country:US
Mailing Address - Phone:304-864-0884
Mailing Address - Fax:
Practice Address - Street 1:519 G ROAD
Practice Address - Street 2:
Practice Address - City:ARTHURDALE
Practice Address - State:WV
Practice Address - Zip Code:26520
Practice Address - Country:US
Practice Address - Phone:304-864-0884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1289290251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005151001Medicaid
WV1316081128Medicaid