Healthcare Provider Details

I. General information

NPI: 1518023472
Provider Name (Legal Business Name): E.A. HAWSE NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 259
BAKER WV
26801-0070
US

IV. Provider business mailing address

PO BOX 70
BAKER WV
26801-0070
US

V. Phone/Fax

Practice location:
  • Phone: 304-897-5903
  • Fax: 304-897-5906
Mailing address:
  • Phone: 304-897-5903
  • Fax: 304-897-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number108
License Number StateWV

VIII. Authorized Official

Name: MR. TODD JONES
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 304-344-1623