Healthcare Provider Details

I. General information

NPI: 1609328608
Provider Name (Legal Business Name): BERKELEY SPRINGS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 AUTUMN ACRES ROAD
BERKELEY SPRINGS WV
25411-3202
US

IV. Provider business mailing address

700 CHAPPELL RD
CHARLESTON WV
25304-2704
US

V. Phone/Fax

Practice location:
  • Phone: 304-258-3673
  • Fax: 304-258-6618
Mailing address:
  • Phone: 304-343-1950
  • Fax: 304-343-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE A PACK
Title or Position: MANAGER
Credential:
Phone: 304-343-1950