National Provider Identifier Database

GRANT MEMORIAL HOMECARE AND HOSPICE LLC
Hospice Care, Community Based


Contact Information

GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
100 HOSPITAL DRIVE
SUITE 2
PETERSBURG, WV26847-9409
Phone: 304-257-2005
Fax: 304-257-2093
Website:
Specialty Taxonomy Code
* Hospice Care, Community Based 251G00000X
Hospice, Inpatient 315D00000X

* Indicates primary specialty

NPI Profile & details for GRANT MEMORIAL HOMECARE AND HOSPICE, LLC

NPI Number 1053579102
Legal business name
LBN
GRANT MEMORIAL HOMECARE AND HOSPICE, LLC
Authorized official JOSHUA PROFFITT - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 05/27/2008
Last updated 09/06/2024 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • WV License #: 16
  • WV Medicaid: 3810013853
  • WV Other: 3810013879 MEDICAID - NURSING HOME

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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