Provider Demographics
NPI:1386837219
Name:NORTHERN WV HOME HEALTH LLC
Entity type:Organization
Organization Name:NORTHERN WV HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-788-1285
Mailing Address - Street 1:690 S MINERAL ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2823
Mailing Address - Country:US
Mailing Address - Phone:304-788-1285
Mailing Address - Fax:304-788-2194
Practice Address - Street 1:690 S MINERAL ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2823
Practice Address - Country:US
Practice Address - Phone:304-788-1285
Practice Address - Fax:304-788-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1007-3456251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0001377002Medicaid
WV0001170001Medicaid
WV0001781002Medicaid