Healthcare Provider Details

I. General information

NPI: 1194283192
Provider Name (Legal Business Name): WEST VIRGINIA HEALTH CARE COOPERATIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FAIRVIEW HEIGHTS RD
SUMMERSVILLE WV
26651-9308
US

IV. Provider business mailing address

400 FAIRVIEW HEIGHTS RD
SUMMERSVILLE WV
26651-9308
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-8402
  • Fax:
Mailing address:
  • Phone: 304-872-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN BOWLING
Title or Position: PRESIDENT/CEO
Credential:
Phone: 304-872-8402