Healthcare Provider Details

I. General information

NPI: 1568847606
Provider Name (Legal Business Name): MARTINSBURG CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CLOVER ST
MARTINSBURG WV
25404-3803
US

IV. Provider business mailing address

7500 MACCORKLE AVE SE
CHARLESTON WV
25304-2935
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-8921
  • Fax: 304-263-2548
Mailing address:
  • Phone: 304-343-1950
  • Fax: 304-343-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number52
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number52
License Number StateWV

VIII. Authorized Official

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