Healthcare Provider Details

I. General information

NPI: 1336069350
Provider Name (Legal Business Name): CLARKSBURG SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2096 DAVISSON RUN RD
CLARKSBURG WV
26301-7361
US

IV. Provider business mailing address

2096 DAVISSON RUN RD
CLARKSBURG WV
26301-7361
US

V. Phone/Fax

Practice location:
  • Phone: 304-624-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SIMCHA WERNER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 917-705-2492