Healthcare Provider Details

I. General information

NPI: 1144337148
Provider Name (Legal Business Name): MINNIE HAMILTON HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 HOSPITAL DRIVE
GRANTSVILLE WV
26147-7100
US

IV. Provider business mailing address

186 HOSPITAL DRIVE
GRANTSVILLE WV
26147-7100
US

V. Phone/Fax

Practice location:
  • Phone: 304-354-9244
  • Fax: 304-354-9323
Mailing address:
  • Phone: 304-354-9244
  • Fax: 304-354-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number150
License Number StateWV

VIII. Authorized Official

Name: MR. STEPHEN S. WHITED
Title or Position: CFO/COO
Credential:
Phone: 304-354-9244