Healthcare Provider Details

I. General information

NPI: 1104980002
Provider Name (Legal Business Name): RESCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 GLENWOOD HAVEN RD
PRINCETON WV
24740-7110
US

IV. Provider business mailing address

PO BOX 1560
PRINCETON WV
24740-1560
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-8745
  • Fax: 304-431-9981
Mailing address:
  • Phone: 304-487-0788
  • Fax: 304-487-2455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number301
License Number StateWV

VIII. Authorized Official

Name: MRS. LISA JONES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-431-3533