Healthcare Provider Details

I. General information

NPI: 1508086703
Provider Name (Legal Business Name): WV VETERANS NURSING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE FREEDOM WAY
CLARKSBURG WV
26301
US

IV. Provider business mailing address

ONE FREEDOM WAY
CLARKSBURG WV
26301
US

V. Phone/Fax

Practice location:
  • Phone: 304-626-1600
  • Fax: 304-626-1605
Mailing address:
  • Phone: 304-626-1600
  • Fax: 304-626-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number#182
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERRI ANN REED
Title or Position: ACTING ADMINISTRATOR
Credential: LNHA
Phone: 304-626-1600