Provider Demographics
NPI:1174588750
Name:PANHANDLE HOME HEALTH INC
Entity type:Organization
Organization Name:PANHANDLE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-263-5680
Mailing Address - Street 1:208 OLD MILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9219
Mailing Address - Country:US
Mailing Address - Phone:304-263-5680
Mailing Address - Fax:304-267-1532
Practice Address - Street 1:208 OLD MILL ROAD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9219
Practice Address - Country:US
Practice Address - Phone:304-263-5680
Practice Address - Fax:304-267-1532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0004895000Medicaid
WV001703810OtherBLUE CROSS BLUE SHIELD
WV001703810OtherBLUE CROSS BLUE SHIELD