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MOUNTAINEER HOME HEALTH, LLC
NPI 1629101910
Home Health in South Charleston, WV

Active since March 14, 2007CLIA 51D1089592 · Waiver
325 4TH AVE, SUITE 5, SOUTH CHARLESTON, WV 25303(304) 720-0205(304) 720-0262 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mountaineer Home Health, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MOUNTAINEER HOME HEALTH, LLC (NPI 1629101910) is a healthcare organization registered as a home health in South Charleston, West Virginia and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through September 21, 2026 and lists Lawrence B Kelly, Ceo, as its authorized official.

NPPES Registry Identity

NPI1629101910
Entity TypeOrganization
Primary Taxonomy251E00000X
Legal Business NameMOUNTAINEER HOME HEALTH, LLC
Location Address325 4TH AVE, SUITE 5South Charleston, WV 25303-1266
Mailing Address325 4th Ave, Suite 5South Charleston, WV 25303-1266 · (304) 720-0205 · Fax (304) 720-0262
Phone(304) 720-0205
Fax(304) 720-0262
Organization SubpartNo
Authorized OfficialLawrence B KellyCeo · (304) 720-0205
Enumeration DateMarch 14, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1629101910 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyHome HealthAgencies
Taxonomy Code251E00000X
Licenses✔ Licensed in WV · 90364✔ Licensed in WV · 2007-011,481
Definition
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.
325 4TH AVE, South Charleston, WV 25303
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Other Identifiers 1

Medicaid0004241000WV

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 51D1089592

Mountaineer Homecare, LLC D/B/A Mountaineer Homecare · Charleston, WV
Active · expires Sep 21, 2026
CLIA Number51D1089592
Laboratory TypeHome Health Agency
Certificate Effective DateSeptember 22, 2024
Certificate Expiration DateSeptember 21, 2026
Laboratory DirectorLori A. Ludwig
Laboratory Phone(304) 720-0205
Laboratory LocationMountaineer Homecare, LLC D/B/A Mountaineer Homecare400 Tracy Way, Suite 100, Charleston, WV 25311
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WHITNEY LYNN ROBERTS
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-5085
ELIZABETH J BEECH
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-5085
KIARA S. JEFFERSON
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-5085
ROBIN DENISE CHRISTIAN
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-4940
KERIONA SHERAY MARTIN
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-4940
JILL MULLINS
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-5085
BROOKE NAOMI MALLORY
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-5085
ANITA SMITH
Technician (Personal Care Attendant)
325 4TH AVE
SOUTH CHARLESTON, WV 25303
Kanawha County (304) 744-5085

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mountaineer Home Health, LLC's NPI number?

The NPI number for Mountaineer Home Health, LLC is 1629101910. It was assigned to this organization in the NPPES registry on March 14, 2007.

Where is Mountaineer Home Health, LLC located?

Mountaineer Home Health, LLC is located at 325 4th Ave Suite 5, South Charleston, WV 25303. The listed phone number is (304) 720-0205.

What is Mountaineer Home Health, LLC's specialty?

The primary specialty registered for this NPI is Home Health with taxonomy code 251E00000X.

Does Mountaineer Home Health, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 51D1089592) is associated with this NPI, valid through September 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mountaineer Home Health, LLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.