Provider Demographics
NPI:1174556641
Name:KANAWHA HOSPICE CARE, INC
Entity type:Organization
Organization Name:KANAWHA HOSPICE CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-768-8523
Mailing Address - Street 1:1606 KANAWHA BLVD W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25387-2536
Mailing Address - Country:US
Mailing Address - Phone:304-768-8523
Mailing Address - Fax:304-768-8627
Practice Address - Street 1:1606 KANAWHA BLVD W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2536
Practice Address - Country:US
Practice Address - Phone:304-768-8523
Practice Address - Fax:304-768-6840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANAWHA HOSPICE CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-08
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0186990251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5564101Medicaid
WV5564101Medicaid