MEDICARE: MANCHIN WVA FACILITY OPERATIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1215818711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANCHIN WVA FACILITY OPERATIONS LLC

Provider Business Mailing Address
First Line	:	401 GUFFEY ST
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-4029
Country	:	US
Telephone Number	:	304-363-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 GUFFEY ST
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-4029
Country	:	US
Telephone Number	:	304-363-2500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAUL PRUITT
Credential	:
Telephone Number	:	616-340-2707

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	11/03/2025

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