Provider Demographics
NPI:1609604602
Name:ENNOBLE HOSPICE WEST VA, LLC
Entity type:Organization
Organization Name:ENNOBLE HOSPICE WEST VA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KUSHABHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-812-9010
Mailing Address - Street 1:11 N CENTRAL AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4212
Mailing Address - Country:US
Mailing Address - Phone:540-288-4622
Mailing Address - Fax:540-288-4622
Practice Address - Street 1:11 N CENTRAL AVE STE 25
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4212
Practice Address - Country:US
Practice Address - Phone:540-288-4622
Practice Address - Fax:540-288-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based