Healthcare Provider Details

I. General information

NPI: 1508933854
Provider Name (Legal Business Name): CHARLESTON ALF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 S PARK RD
CHARLESTON WV
25304-2627
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-4663
  • Fax:
Mailing address:
  • Phone: 610-925-4436
  • Fax: 610-925-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number507450
License Number StateWV

VIII. Authorized Official

Name: JANE DROPESKEY
Title or Position: CORPORATE MANAGER
Credential:
Phone: 610-925-4231