Healthcare Provider Details

I. General information

NPI: 1518021625
Provider Name (Legal Business Name): RESCARE WEST VIRGINIA, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 W MAIN ST
SALEM WV
26426-1223
US

IV. Provider business mailing address

1618 BUCKHANNON PIKE
NUTTER FORT WV
26301-4465
US

V. Phone/Fax

Practice location:
  • Phone: 304-782-3068
  • Fax: 304-782-3068
Mailing address:
  • Phone: 304-326-0140
  • Fax: 304-326-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number335
License Number StateWV

VIII. Authorized Official

Name: MRS. JACKIE CANFIELD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 304-326-0140