Provider Demographics
NPI:1730386558
Name:YOUR CHOICE HOME CARE LLC
Entity type:Organization
Organization Name:YOUR CHOICE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-392-6270
Mailing Address - Street 1:530 GRAY GABLES RD
Mailing Address - Street 2:
Mailing Address - City:CRAWLEY
Mailing Address - State:WV
Mailing Address - Zip Code:24931
Mailing Address - Country:US
Mailing Address - Phone:304-392-6270
Mailing Address - Fax:304-392-6354
Practice Address - Street 1:530 GRAY GABLES RD
Practice Address - Street 2:
Practice Address - City:CRAWLEY
Practice Address - State:WV
Practice Address - Zip Code:24931
Practice Address - Country:US
Practice Address - Phone:304-392-6270
Practice Address - Fax:304-392-6354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003786Medicaid
WV3810003785Medicaid