Healthcare Provider Details

I. General information

NPI: 1972665040
Provider Name (Legal Business Name): CMO MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 4TH ST
RICHWOOD WV
26261-1203
US

IV. Provider business mailing address

18 4TH ST
RICHWOOD WV
26261-1203
US

V. Phone/Fax

Practice location:
  • Phone: 304-846-2668
  • Fax: 304-846-4851
Mailing address:
  • Phone: 304-846-2668
  • Fax: 304-846-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number85
License Number StateWV

VIII. Authorized Official

Name: MR. MOSHE M ORLLINSKY
Title or Position: MANAGER
Credential:
Phone: 304-846-2668