Jorge Mondragon
Individual provider Active NPI Personal Care Attendant · Mannington, WV
NPI 1053913137 · NPPES record last updated Nov 12, 2020
Key facts
- NPI
- 1053913137
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Practice address
- 311 Plum Run Rd
Mannington, WV 26582-7279 - Phone
- (304) 694-6423
- NPI assigned
- Nov 12, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | Yes |
Addresses
Primary practice location
311 Plum Run Rd
Mannington, WV 26582-7279
Mailing address
311 Plum Run Rd
Mannington, WV 26582-7279
Phone (304) 694-6423
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3046946423 | Medicaid | WV |
Other providers in Mannington, WV
- Olivia Paige Mayfield
- Amanda May McAbee
- Cheryl Lynn McCarty
- Martha Kay McCoy
- Elizabeth Millard
- Monongahela Valley Association of Health Centers, Inc.
- Monongalia County General Hospital Company
- Christopher J Moore
- Judy Morgan
- Mandy L. Nestor
All providers in Mannington, WV · Personal Care Attendant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.