Healthcare Provider Details

I. General information

NPI: 1922100031
Provider Name (Legal Business Name): MORGANTOWN HEALTHCARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 VANDERVORT DR
MORGANTOWN WV
26505
US

IV. Provider business mailing address

PO BOX 636
MORGANTOWN WV
26507-0636
US

V. Phone/Fax

Practice location:
  • Phone: 304-285-2720
  • Fax: 304-285-2727
Mailing address:
  • Phone: 304-285-2720
  • Fax: 304-285-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number63
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number63
License Number StateWV

VIII. Authorized Official

Name: NICHOLAS S GRUBBS
Title or Position: CFO
Credential:
Phone: 304-598-1205