MEDICARE: RESCARE WEST VIRGINIA, INC.

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	337	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386709939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESCARE WEST VIRGINIA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:	251 GORE RD
City	:	GORE
State	:	VA
Zip	:	22637-0130
Country	:	US
Telephone Number	:	540-858-2572
Fax Number	:	540-858-2575

Provider Business Practice Location Address
First Line	:	1207 W VIRGINIA AVE
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-1643
Country	:	US
Telephone Number	:	304-263-4871
Fax Number	:	304-263-4871

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MARK LANDIS
Credential	:
Telephone Number	:	540-858-2572

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	08/22/2020

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