Provider Demographics
NPI:1972395705
Name:BURGESS, REXFORD JR
Entity type:Individual
Prefix:
First Name:REXFORD
Middle Name:
Last Name:BURGESS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 CROSS LANE RD
Mailing Address - Street 2:
Mailing Address - City:LERONA
Mailing Address - State:WV
Mailing Address - Zip Code:25971-9610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:189 CROSS LANE RD
Practice Address - Street 2:
Practice Address - City:LERONA
Practice Address - State:WV
Practice Address - Zip Code:25971-9610
Practice Address - Country:US
Practice Address - Phone:304-992-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide