Provider Demographics
NPI:1447854278
Name:TAYLOR, LISA SHIRL
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SHIRL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:SHIRL
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:912 FOLA RD
Mailing Address - Street 2:
Mailing Address - City:BICKMORE
Mailing Address - State:WV
Mailing Address - Zip Code:25019-9764
Mailing Address - Country:US
Mailing Address - Phone:304-689-0986
Mailing Address - Fax:
Practice Address - Street 1:ADVANTAGE HOME CARE 15 BANK ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25019
Practice Address - Country:US
Practice Address - Phone:304-587-9992
Practice Address - Fax:304-587-9993
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant