MEDICARE: MINGO CARE CENTER, 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	313M00000X	Nursing Facility/Intermediate Care Facility	92	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	:	1730177130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINGO CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	100 HILLCREST DR
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3948
Country	:	US
Telephone Number	:	304-235-7005
Fax Number	:	304-752-8768

Provider Business Practice Location Address
First Line	:	100 HILLCREST DR
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3948
Country	:	US
Telephone Number	:	304-235-7005
Fax Number	:	304-752-8768

Authorized Official
Title or Position	:	CHIEF OF OPERATIONS & FINANCE
Name	:	MR. THOMAS SPHATT
Credential	:
Telephone Number	:	304-752-8761

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	08/22/2020

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Directions to “MINGO CARE CENTER, INC. ” Practice Location

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