MEDICARE: RSCR 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	383	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	:	1629133269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RSCR WEST VIRGINIA, INC.

Provider Business Mailing Address
First Line	:	9901 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3808
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CORNELL ST
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-2140
Country	:	US
Telephone Number	:	304-788-0101
Fax Number	:	304-788-8097

Authorized Official
Title or Position	:	ASSOC. GEN. COUNSEL/PRIVACY OFFICER
Name	:	MS. DEENA G. OMBRES
Credential	:
Telephone Number	:	502-394-2387

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	11/21/2011

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