Healthcare Provider Details

I. General information

NPI: 1720081615
Provider Name (Legal Business Name): FAYETTE COMMUNITY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 23RD ST
OAK HILL WV
25901-2830
US

IV. Provider business mailing address

422 23RD ST
OAK HILL WV
25901-2830
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-1903
  • Fax: 304-949-3807
Mailing address:
  • Phone: 304-465-1903
  • Fax: 304-949-3807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number129
License Number StateWV

VIII. Authorized Official

Name: MR. CALVIN L SUTPHIN II
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 304-465-1903