Healthcare Provider Details

I. General information

NPI: 1164410775
Provider Name (Legal Business Name): VALLEY HAVEN GERIATRIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RD#2 BOX 44
WELLSBURG WV
26070-9505
US

IV. Provider business mailing address

RD#2 BOX 44
WELLSBURG WV
26070-9505
US

V. Phone/Fax

Practice location:
  • Phone: 304-394-5322
  • Fax: 304-394-1242
Mailing address:
  • Phone: 304-394-5322
  • Fax: 304-394-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number113
License Number StateWV

VIII. Authorized Official

Name: MR. MICHAEL L ANDERSON
Title or Position: PRESIDENT-ADMINISTRATOR
Credential:
Phone: 304-394-5322